Spinal Mobility Problems Common, and Worsen Over Time, Swedish Study Shows

Spinal Mobility Problems Common, and Worsen Over Time, Swedish Study Shows

Problems in spinal mobility are common in people living with ankylosing spondylitis (AS) for more than 10 years, a Swedish study shows.

The most prevalent problem is difficulty in bending the spine sideways, which associates with worse mobility problems later on.

The study, “Long‐term spinal mobility in ankylosing spondylitis: a repeated cross‐sectional study,” was published in the journal Arthritis Care & Research.

Ankylosing spondylitis (AS) is a form of arthritis that primarily affects the spine, causing inflammation of the spinal joints (vertebrae) that can lead to severe, chronic pain and stiffness. In more advanced cases, the disease can eventually progress to ankylosis — new bone formation in the spine that leads to the ossification of ligaments, and causes sections of the spine to fuse.

The hallmark sign of AS is inflammation of the sacroiliac joints, where the base of the spine (the sacrum) meets the pelvis (iliac bone). This is accompanied by decreased spinal mobility.

As a lifelong disease, AS typically begins to show symptoms in early adulthood, which gradually worsen. But severity varies from person to person.

Because the decrease in spinal mobility is a slow process which worsens over decades, studies on the condition are scarce, and have been done primarily with the use of old records.

Now, researchers took advantage of a Swedish database of spinal mobility records in AS patients spanning nearly 40 years, to learn more. The team from the Department of Public Health and Clinical Medicine at Umeå University, in Sweden, conducted a retrospective study to evaluate the prevalence of spine movement problems in patients with long-standing disease.

They also investigated whether impaired lateral spinal flexion (LSF) — the ability to bend the spine sideways — in early-stage disease is associated with a worse prognosis. The team examined which type of reference levels were better for evaluating patient changes in spine motion: the commonly used, fixed reference values, or age-adjusted reference intervals from healthy people.

Spinal mobility data was compiled for 232 people with ankylosing spondylitis — 186 men and 46 women — who had been living with the disease for up to 45 years. This data set included 3,849 spine clinical measurements collected between 1980 and 2016.

Measurements of LSF, 10‐cm Schober test (a measure of lumbar, or lower back, spine flexion), chest expansion, and cervical rotation (head rotation) were grouped by duration of disease in 10‐year intervals — at 10, 20, 30, and 40 years of disease duration. Measurements closest to each of these intervals, and within five years before or after, were used.

These values were compared with published age‐ and height‐adjusted references, and with fixed reference values commonly used in clinical practice in Sweden.

As expected, spinal mobility was generally lower in patients than in the age-corresponding healthy population, with the proportion of those with spinal problems increasing over time.

This impairment was found in all evaluated parameters, except for chest expansion, and was especially pronounced for lateral spinal flexion.

For all disease periods, of 10 to 40 years, people with the disease had a mean LSF below the values found in 97.5% of healthy people (53% of male patients and 65% of females).

Importantly, the researchers found that reduced LSF after 10 years of disease was associated with worse ability to move the spine later on. The team compared patients with normal LSF with those with impaired LSF after 10 years of disease. Those with later impaired LSF — after a mean of 30 years of disease — experienced both worse and more frequently impaired mobility in all measurements.

In another key finding, using fixed reference values for evaluating impaired spinal mobility overestimated the proportions of patients with the condition as compared with the use of adjusted reference intervals, the investigators said.

This finding was most evident for chest expansion after 40 years of disease. Only 8% of patients were classified as having impaired spinal mobility using age-adjusted reference intervals, in contrast with 52% and 74% of patients, depending on the cut-off, using fixed reference values.

“In conclusion, impaired spinal mobility in AS is common after 10 years of disease and spinal mobility continues to deteriorate in the succeeding decades. Early impairment of spinal mobility, although often limited in absolute numbers, is associated with a worse prognosis,” the researchers said.

They explained that spinal mobility can become limited in these patients either due to the progression of structural changes, as observed in radiographic exams, or due to pain and muscular spasms caused by inflammation.

“The use of age- and height-adjusted reference intervals could significantly improve spinal mobility assessment during the course of AS disease. The use of fixed reference values lacks precision, overestimates the proportion with impaired spinal mobility in AS, must be used with extreme caution, or should preferably be avoided,” the team added.

To ease the use of adjusted references in clinical practice, computer systems may be applied to electronic patient records or national quality registers, the team suggested.

Ana Pena Author
Ana is a molecular biologist enthusiastic about innovation and communication. In her role as a science writer she wishes to bring the advances in medical science and technology closer to the public, particularly to those most in need of them. Ana holds a PhD in Biomedical Sciences from the University of Lisbon, Portugal, during which she focused her research on molecular biology, epigenetics and infectious diseases.
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Ana Pena Author
Ana is a molecular biologist enthusiastic about innovation and communication. In her role as a science writer she wishes to bring the advances in medical science and technology closer to the public, particularly to those most in need of them. Ana holds a PhD in Biomedical Sciences from the University of Lisbon, Portugal, during which she focused her research on molecular biology, epigenetics and infectious diseases.

3 comments

  1. Katheryn Willis says:

    I have a Question I’m trying to find some answers. my son of 27 year of age had been diagnosed over 4 years ago with this disease Ankylosing Spondylitis, and is thinking of joining the peace core. I believe he is in denial of his ability to do things that this program would need from him and may put he health at risks. I’m wondering if there was any one or a place that I could get in touch with the could inform me of the risks that he would be putting himself in at a 3rd world country?
    Thank you For your help with this!

    • Steven Anthony says:

      Katheryn,

      Your son’s desire to join the Peace Corps is admirable. Like your son, I also have AS and I joined the military at age 20. Symptoms had already begun to manifest but I wasn’t diagnosed until many years later. Prior to getting diagnosed, I dealt with the associated pain and inflammation with NSAIDs (aleve, 2 pills/day). I was even able to get through a year long combat tour in Afghanistan pretty well like this. Even though my symptoms were managed, the NSAIDs just reduced the inflammation and not eliminate it so damage was still occurring to my spine. Around age 30, I consulted with a rheumalogist that put me on a biologic medication (injection) Humira. This worked well but again, just reduces inflammation and comes with a slew of other medical concerns. So fast forward, I’m 38 now and my spinal mobility has reduced significantly and my back frequently feels tweaked. I wake up every morning stiff and have a harder time standing up straight. I’ve had some very rough patches both physically and mentally due to my AS.

      Your motherly instinct is probably correct but depending on your son’s ability to deal with his symptoms, hopefully he has a good idea of how much he can handle. The environment the Peace Corp would put him in I’m sure would be both personally rewarding and physically challenging all things considered. It will come with a price though, mine did and I’m paying for it now.

      It was worth it!

    • Gary says:

      I mostly agree with Steven’s response although I did not have his experience in the military, and I did not have really bad symptoms of AS until I was in my 50’s. Your son is probably the best judge of his capabilities and as long as the Peace Corps (with a “p”, at least you didn’t say corpse-man like the pres) is aware of the situation, I bet it would be a valuable experience. Biologics (Enbrel – Humira worked but was incompatable with me) made all the difference in the world – stopping most damage – although it couldn’t help my eyes – astaxanthin may have finally helped with that. Everyone is different and youth usually triumphs. Knowing what you are dealing with ebables you to do the most. When things are good, which is not always, there may be no limitations.

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