Spondylitis: Information & Spondylitis Specialists

Spondylitis is considered a rare inflammatory disease in Europe. According to statistics, fewer than 22 people per 1 million are diagnosed with spondylitis each year.

In most cases, the inflammation is caused by a bacterial infection in the spine. The vertebral bodies are particularly affected.

In some cases, the inflammation spreads into the bone marrow—doctors refer to this as osteomyelitis.

Other specific forms of spondylitis include

• Tuberculous spondylitis: caused by tuberculosis,
• Brucellotic spondylitis: caused by brucellosis,
• Ankylosing spondylitis: a chronic inflammatory disease of the spine, known as Bechterew’s disease.

Spondylitis is caused by bacteria or fungi that enter the spine or the vertebral bodies. The main routes of infection are

• the bloodstream,
• the lymphatic system, and
• injections and punctures, e.g., following an injury.

People who suffer from spondylitis or spondylodiscitis are often older. Therefore, advanced age is one of the risk factors for developing these diseases.

Various comorbidities also increase the risk of spondylitis, including:

• diabetes mellitus,
• obesity,
• kidney disease,
• alcohol abuse / tobacco use,
• other chronic or immunosuppressive infections, such as HIV infection.

Ankylosing spondylitis, on the other hand, belongs to the group of rheumatic diseases. People with the HLA-B27 gene have a higher familial risk for this autoimmune disease. However, the exact cause of ankylosing spondylitis remains unknown.

In spondylitis, inflammation develops in the spine. The vertebral bodies are often affected © bilderzwerg | AdobeStock

In the early stages, spondylitis is usually asymptomatic. As the disease progresses, pain eventually develops, primarily localized to the affected vertebral segment. However, the pain can also radiate into the arms and legs.

In particular,

• the lumbar vertebrae,
• the sacrum, and
• to some extent the cervical spine

are more frequently affected.

In addition, a general feeling of illness accompanied by fever and chills may occur. Sensory disturbances and/or limited mobility are also possible in advanced stages.

If the disease remains untreated for a long time, it can lead to inflammatory changes in the spine, potentially resulting in the destruction of individual vertebral structures.

The medical examination always begins with a medical history interview. During this interview, the doctor determines which symptoms have been present and since when. It is also important to determine whether there is a family history of the described symptoms and possible related conditions.

Based on this medical history, doctors typically arrive at a list of differential diagnoses. The doctor then assesses characteristic symptoms and signs through a physical examination, including inflammation markers and a complete blood count.

At the end of these examinations, a presumptive diagnosis is made. 

Subsequent imaging tests are used to confirm this suspected diagnosis. In cases of unexplained spinal pain, an X-ray is the first-line imaging test.

However, for a definitive diagnosis of “spondylitis,” magnetic resonance imaging (MRI) is the method of choice. MRI allows for much more detailed images. These images make it possible to more accurately describe the extent and stage of inflammation along the spine.

Depending on the stage of inflammation, spondylitis is treated conservatively with antibiotics. During this time, the spine can be stabilized and immobilized with a brace.

In the early stages of the disease, the primary goal is to prevent the infection from spreading further. This can help avoid the need for spinal surgery.

However, surgery is necessary if the spondylitis has spread to the intervertebral discs and caused purulent inflammation there—a condition known as spondylodiscitis. The goal of the surgery is to remove the source of inflammation.

During the surgery, surgeons remove the affected intervertebral disc and the damaged bone tissue from the vertebral body. They fill the resulting gaps with bone substitute material.

Antibiotics must still be taken even after surgery.

The causes that ultimately trigger spondylitis are unknown. For this reason, it is not easy to prevent this inflammatory condition.

However, there are a few factors associated with an increased risk of spondylitis. You can take steps to prevent these factors:

• Diabetes mellitus,
• overweight/obesity,
• cardiovascular disease,
• kidney disease,
• liver damage caused by alcohol abuse, and
• drug use.

If you consistently avoid or treat these risk factors and comorbidities, your risk of developing spondylitis decreases.

Otherwise, the following applies: If you experience unexplained back pain, with or without fever, you should consult a specialist. When detected and treated early, spondylitis has a good prognosis in the majority of cases.