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Marie Strumpell’s bamboo spine

“Sore, stiff with many toils, sicken’d and nigh to death,”

— Walt Whitman (1819-1892), US poet
“Prayer of Columbus”
Dr. Brix Pujalte is an orthopedic surgeon. E-mail jsp@pldtdsl.net Webpage
By Dr. Jose S. Pujalte Jr.

I SUPPOSE that for most people, one sure sign of growing older is having difficulty in bending forward or
squatting to pick up something dropped like a ballpen or a bunch of keys. But what if you’re just between
20 and 40 and your back is already, in the words of the poet, "sore, stiff with many toils"? If you haven’t
injured your back and the back pain has not gone away for weeks, it’s best to investigate.

Ankylosing Spondylitis (Marie Strumpell disease). We are all familiar with osteoarthritis, the most
common form of arthritis. Less known is a group of arthritic disorders called the spondyloarthropathies to
which ankylosing spondylitis or AS belongs. The cause of AS is unknown and it affects more males than
females. The only risk factor is having a family member who has it – the risk increasing by 15 to 20
percent. It’s said that it occurs in one out of every 100 people. A clinical definition of ankylosing
spondylitis is persistent pain and stiffness of the back (more than three months) localized to the sacro-iliac
joints (the parts where the back bones join the pelvis), morning stiffness, and get this – improvement
with exercise and worsening with rest.

Signs and symptoms. Aside from those mentioned, other clues are:

Low grade fever; inflammation of the colored part of eye or iris (iritis); limited expansion of the chest; hip
pain and stiffness; neck pain and stiffness; chronic stooping to relieve back pain; joint pain and swelling of
the shoulders, knees, and ankles; weight loss; fatigue; and limited movement of the spine and hips.

Diagnosis. Take time to look for the right doctors in terms of specialty. These would ideally be the
rheumatologist or the orthopedic surgeon. For eye complaints, see an ophthalmologist. After taking a
complete history, the good doctor may check how stiff your back has become. After marking spots at the
level of the dimples of Venus (corresponding to the 5th lumbar or back bone) and 10 cm above while
upright, the doctor then asks you to bend forward. If on bending, the spine does NOT lengthen by more
than 15cm, there is reduced flexion (a positive Schober test). In late AS, the spine on xray looks like a
bamboo pole (hence, the "bamboo spine’). Laboratory exams include an antigen test for HLA-B27 (usually
this gene is present in those with spondyloarthropathies) and other blood exams that confirm chronic

Treatment. There is no cure for ankylosing spondylitis. Still, doctors aim to improve the patient’s quality
of life by reducing inflammation (corticosteroids), eliminating pain (non-steroidal anti-inflammatory drugs
and COX-2 inhibitors) and delaying stiffness of the hips and spine. Initial treatment requires the
supervision of the physiatrist (rehabilitation medicine expert) who will design a physical therapy program
that focuses on strengthening exercises to keep the torso upright and breathing optimal.
Immunosuppresants are also used to slow the progression of AS. The ophthalmologist may also want to
reduce eye inflammation with corticosteroids. In severe cases, the orthopedic surgeon may correct spine
deformities and replace the hip joints with artificial articulating parts (total joint replacement).

There is no known prevention for ankylosing spondylitis. Nevertheless, if caught early, it need not
significantly curtail freedom of movement that the normal body takes for granted, like picking up a ballpen
or a bunch of keys.

Billboard. Rainy season comfort food: Where else but at Café Ysabel (455 P. Guevarra St., San Juan,
Metro Manila). Try the pasta dishes (you can’t go wrong with classic spaghetti with meatballs) and the
pizza. Best eaten on a cold, wet day.

Fact/Factoid. Visual dieting cue: A serving of nuts is the size of a golf ball.