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Treatment: spinal surgery 

Treatment: spinal surgery
Chapter:
Treatment: spinal surgery
Author(s):

Heinrich Boehm

and Y. Raja Rampersaud

DOI:
10.1093/med/9780198734444.003.0023
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date: 19 February 2019

Despite remarkable progress in understanding the pathological processes and alleviating symptoms by TNFα‎ blocking medication, the mechanism that converts flexible tissue into bone still cannot be completely prevented or reversed. In axial spondyloarthritis, components of motion segments, such as zygoapophyseal joints, intervertebral discs, and spinal ligaments, can ossify in varying sequence, extent, and location between the ilium and occiput. Throughout this process, the spinal column is vulnerable to kyphotic deformity due to gravity, body weight, muscle action, and life’s flexion-based activities. Areas with low fusion tendency, such as atlanto-axial joints, and post-traumatically weakened spots of formerly ankylosed vertebral block (Andersson’s lesion) can endanger the spinal cord by instability, dislocation, and compression, from what is typically minor trauma or simple repetitive, but otherwise normal, stresses. Once functionally significant deformity or presence of instability and associated symptoms are established, conservative treatment options are lacking and surgical consideration is required.

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