Ankylosing spondylitis

This disease of the sacroiliac joints and spine occurs four times more frequently in men than in women. Vertebral involvement ascends from the lumbar to the cervical regions and results in complete immobility of the spine. Vertebrobasilar insufficiency can occur, and spinal stenosis may produce the cauda equina syndrome.

Complete ankylosis increases the risk of cervical fracture which may be difficult to diagnose or visualize radiographically and can result from a trivial injury. Postural problems are exacerbated by flexion deformity of the hips. The condition is associated with aortic insufficiency and mitral regurgitation, and preoperative echocardiography is useful in assessing the degree of involvement and looking for cardiomegaly. Associated conduction defects and heart block may require use of a pacemaker. Chest wall immobility produces a restrictive respiratory pattern, and occasonally apical pulmonary fibrosis is present. These patients are particularly prone to pulmonary barotrauma during intermittent positive-pressure ventilation. Preoperative lung function and arterial blood gas analysis provide guidance for postoperative management and the need for postoperative ventilatory support.

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