EpistemisGlobal spinal rigidity
Specialty: Musculoskeletal.
Why it occurs
- Advanced ankylosing spondylitis (fusion of the vertebral bodies due to syndesmophytes)
- Diffuse idiopathic skeletal hyperostosis (Forestier-Rotés disease)
- Severe multisegmental degenerative lumbar and cervical spondylosis
- Psoriatic spondyloarthritis with extensive axial involvement
- Chronic neuromuscular disorders with severe axial spasticity
- Juvenile idiopathic arthritis with late spinal fusion
Initial workup
Complete AP and lateral spine x-ray (evaluates syndesmophytes, ligament ossification and the classic "bamboo spine") | Total spine MRI if there is superimposed acute pain | HLA-B27 in blood | Spirometry (to assess restrictive pattern due to costovertebral limitation).
red flags
Sudden or progressive loss of thoracic expansion capacity (measured in the fourth intercostal space < 2.5 cm) associated with severe restrictive dyspnea, or paresthesias and weakness in all four extremities after minor cervical flexion and extension (cervical myelopathy due to atlantoaxial instability).
Standard management
- Etoricoxib — 90 mg once a day orally continuously, basis of treatment in active spondyloarthritis
- Secukinumab — 150-300 mg subcutaneously once a month after induction dose; Anti-IL-17A Biological Therapy for Active Axial Spondyloarthritis
- Sulfasalazine (1 g every 12 hours orally; indicated if there is concomitant peripheral joint involvement).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3