Neurological symptoms of ankylosing spondylitis (AS)

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AS primarily affects the spine and sacroiliac joints, which link the pelvis and lower spine. However, as the condition progresses, inflammation and structural changes can also involve the peripheral joints and other organs, including the nervous system.

Neurological symptoms in AS can occur due to bone spurs or after spinal fusion surgery. Additionally, inflammation of the spinal cord can compress spinal nerve roots, causing neurological symptoms.

These neurological symptoms are more common in advanced disease stages when there is significant spinal involvement. As the condition progresses, individuals may experience worsening spinal complications. This raises the risk of nerve compression and neurological complications.

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AS can lead to:

Spinal cord compression

Spinal cord compression is pressure on the spinal cord, and it prevents the nerves from working as they usually would. It can cause back pain and other symptoms, such as weakness and incontinence.

Without treatment, it can result in complications and irreversible neurological deficits, including:

• paralysis
• gait disturbances, affecting the way a person walks
• sensory loss
• urinary and fecal incontinence
• urinary retention

Cauda equina syndrome

This is a rare but serious condition. Cauda equina syndrome can occur as a result of nerve compression at the lower end of the spinal cord. Without treatment, there may be permanent damage.

Symptoms of cauda equina syndrome include:

• bladder and bowel dysfunction
• incontinence
• urinary retention
• sexual dysfunction
• sciatica
• numbness or weakness in the legs
• difficulty with balance and coordination

Peripheral neuropathy

Peripheral neuropathy refers to many conditions involving damage to the peripheral nervous system.

Symptoms depend on the type of nerve fibers and the severity of damage. These symptoms may develop over days, weeks, or years.

Symptoms may include:

• muscle weakness
• painful cramps
• uncontrollable muscle twitching visible under the skin
• muscle shrinking
• numbness
• tingling
• muscle weakness in the arms, legs, or other parts of the body

If a person has long-standing AS and is experiencing any of these symptoms, a rheumatologist can refer them to a neurologist for consultation.

Diagnosing neurological symptoms in AS requires a comprehensive evaluation by a healthcare professional.

Tests may include:

• Physical examination: This involves assessing muscle strength, reflexes, sensation, and coordination and can help identify neurological deficits.
• Imaging studies: X-rays, MRI, or CT scans can show changes in the spinal cord, nerve roots, and surrounding areas.
• Electrodiagnostic tests: Electromyography (EMG) and nerve conduction tests can evaluate nerve function and identify areas of nerve compression or damage.
• Myelogram: This is a type of X-ray that involves injecting a contrast dye into the spinal canal and surrounding cerebrospinal fluid spaces. It can show displacement of the spinal cord or nerves, which may have occurred due to herniated discs, bone spurs, or tumors.

Treating neurological symptoms in AS aims to help relieve pain, improve function, and prevent further neurological damage.

It is important to seek treatment as early as possible to help prevent symptoms from worsening or causing permanent damage.

Treatment options may include:

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs) can help reduce inflammation and relieve pain.
• Physical therapy: Physical therapy, such as stretching exercises, strengthening exercises, and postural training, can lower the risk of nerve compression and improve mobility.
• Spinal injection therapy: Epidural steroid injections can help relieve pain in the back or legs. It involves a minor procedure in the hospital to have an injection in the back.
• Surgical intervention: In severe cases of spinal cord compression or cauda equina syndrome, lumbar decompression surgery may be necessary. It helps relieve pressure on the nerves.

The outlook for neurological symptoms in AS varies depending on the severity of spinal involvement and when a person receives treatment. Early recognition and intervention can help prevent permanent neurological damage and improve long-term outcomes.

However, advanced cases of spinal cord compression or cauda equina syndrome may result in persistent neurological issues despite treatment.

While it may not always be possible to prevent neurological symptoms in AS, certain measures can help minimize the risk of complications:

• Regular monitoring: Routine follow-up visits with a healthcare professional can help detect neurological symptoms early and prevent progression.
• Medication adherence: Following directions about how and when to take medications can help manage inflammation and flare-ups.
• Maintain correct posture: Having correct posture and avoiding prolonged periods of sitting — or standing — can help reduce strain on the spine.

Neurological symptoms in AS commonly arise at a later stage and may include numbness, tingling, weakness, and loss of bowel or bladder control.

These symptoms require prompt recognition and intervention. This helps prevent permanent damage to the nervous system and improves long-term outcomes.

Although there is no cure for AS, several ways exist to manage neurological symptoms. This might include physical therapy and medications. With appropriate management, a person can help improve their quality of life.