Ankylosing Spondylitis & Scoliosis: Key Differences & Treatment Options

Ankylosing spondylitis and scoliosis can both lead to significant back issues, but they stem from different causes and require different treatments.

If you’re trying to figure out the main differences between these conditions and how to manage them, this article breaks it down for you. We’ll explore their unique symptoms, causes, and treatment strategies to increase your knowledge and understanding of these conditions.

What is the difference between ankylosing spondylitis & scoliosis?

Ankylosing spondylitis (AS) is an autoimmune disease that primarily affects the spine, causing inflammation in the joints and ligaments. This inflammation often leads to persistent lower back pain and stiffness. About 0.2% to 0.5% of the American population is affected by AS¹.

In advanced stages of AS, the vertebrae in the spine may fuse together, a condition sometimes called “bamboo spine” due to its appearance on X-rays. This fusion can result in complete spinal fusion, which is often visible on X-rays. Other changes that may be seen include calcium deposits in the ligaments and discs, as well as old spinal fractures.

Scoliosis, on the other hand, involves a sideways curvature of the spine, which can affect posture and cause discomfort or pain. About 2-3% of the US population has scoliosis. Scoliosis can be present at birth (congenital) or develop later in life².

While both conditions involve changes to the spine, their effects are different. Ankylosing spondylitis can also affect other joints, eyes, skin, and organs, making it a complex condition that requires comprehensive medical care. Whereas scoliosis primarily affects spinal alignments and can usually be left untreated when it's not severe.

Ankylosing spondylitis symptoms vs scoliosis symptoms

Recognizing the distinct symptoms of ankylosing spondylitis and scoliosis is key, because both conditions impact the spine in unique ways. AS typically leads to pain and stiffness, especially in the lower back. In contrast, scoliosis is marked by a noticeable curve in the spine.

Ankylosing spondylitis symptoms

Ankylosing spondylitis presents with symptoms that can significantly impact daily life. Persistent low back pain and stiffness in the spine are primary signs of AS, which typically improve with exercise but worsen during rest. This pattern of symptoms is a key clue for health professionals when diagnosing AS. Discomfort can also occur in other joints, including the hips, shoulders, and even smaller joints like those in the hands and feet.

As ankylosing spondylitis progresses, individuals may experience additional symptoms beyond joint issues, such as:

• eye inflammation, which can cause pain, light sensitivity, and redness
• a profound sense of fatigue that doesn't improve with rest
• digestive problems, such as abdominal pain or diarrhea
• unintentional weight loss, either due to gastrointestinal issues or widespread inflammation.

A serious concern with ankylosing spondylitis is its potential to affect breathing. AS can impact the joints between the ribs and spine, leading to chest tightness and breathing difficulties, especially during physical activities or while lying down. It's important to note that the severity and pattern of symptoms can vary greatly between individuals. Symptoms may flare up and then subside, entering periods of stability or remission.

If you experience persistent lower back pain that seems to get better with movement but gets worse when you rest, along with any of these additional symptoms, it’s important to seek a medical evaluation as soon as possible.

Scoliosis symptoms

In contrast to ankylosing spondylitis, scoliosis is marked by noticeable misalignments due to the spine’s unusual curvature.

The symptoms of scoliosis can vary depending on the severity of the curve and individual differences. In many cases, especially with mild scoliosis, there may be no noticeable symptoms. However, some common signs and symptoms to look out for include:

Visible signs:

• Uneven shoulders: One shoulder may appear higher than the other.
• Uneven hips: One hip may look higher or more prominent than the other.
• Prominent shoulder blade: One shoulder blade may stick out more than the other.
• Uneven waist: The waist may appear uneven or shifted to one side.
• Rib hump: A hump may be visible on one side of the back when bending forward.
• Head not centered: The head may not appear centered over the body.

Other symptoms:

• Back pain: While not always present, some people with scoliosis may experience back pain.
• Leg pain, numbness, or weakness: In severe cases, scoliosis can put pressure on nerves, leading to pain, numbness, or weakness in the legs.
• Breathing difficulties: In severe cases with large curves, the rib cage can compress the lungs, leading to breathing difficulties.

Can you have ankylosing spondylitis & scoliosis?

Yes, it is possible to have both conditions. While scoliosis is not a typical feature of ankylosing spondylitis, there is some evidence suggesting a possible link between the two conditions. However, more research is needed to fully understand this relationship.

A 2022 study from Taiwan found that people with scoliosis were more likely to have ankylosing spondylitis compared to the general population. However, further research is needed to confirm this association in other groups³.

What are the causes of ankylosing spondylitis & scoliosis?

The exact cause of ankylosing spondylitis is unknown, while scoliosis can stem from different sources based on how it’s categorized.

Causes of ankylosing spondylitis

The most likely cause of AS is genetic. If you have family members with ankylosing spondylitis, this significantly increases your risk of having AS too, especially if it a close relative such as a parent or sibling⁴.

Causes of scoliosis

Scoliosis has a range of potential causes, which vary based on the type. It is classified into three primary categories: idiopathic scoliosis, congenital scoliosis, and neuromuscular scoliosis. The underlying factors contributing to the onset and progression of spinal deformity differ for each category.

The most common form of scoliosis in adolescents is idiopathic scoliosis. Its exact cause is still unknown, but researchers believe hereditary factors play a significant role in its development.

In contrast, congenital scoliosis is present at birth and occurs due to vertebral anomalies that arise during fetal development. These anomalies cause the spine to form incorrectly and can sometimes affect the spinal cord itself.

Neuromuscular scoliosis is caused by factors affecting the muscles and nerves in the body. For example, a condition that causes poor muscle control, weakness, or paralysis can, in some cases, lead to neuromuscular scoliosis. Similarly, neurological (nerve) problems, such as cerebral palsy, spina bifida, or muscular dystrophy can cause the spine to curve.

How is AS diagnosed vs scoliosis diagnosed?

The diagnostic journey for conditions like ankylosing spondylitis (AS) and scoliosis typically begins with a thorough physical examination and may include additional tests to confirm the presence of the disease and assess its severity.

While these conditions share some similarities in their diagnostic procedures – such as using imaging technologies like X-rays and MRI scans – they each have unique criteria and specialized approaches for diagnosis.

Ankylosing spondylitis

The process of diagnosing ankylosing spondylitis typically begins with a thorough review of the patient’s medical history and symptoms. During physical examinations, healthcare practitioners evaluate spinal mobility and check for areas of discomfort or sensitivity, focusing particularly on the sacroiliac joints (where the spine meets the pelvis).

Overall, the methods used to diagnose AS include:

• reviewing the patient’s medical history
• conducting targeted physical examinations
• obtaining necessary imaging scans
• performing relevant lab tests.

Scoliosis

The assessment for scoliosis usually starts with a thorough physical examination. Health professionals check for signs of a curved spine, such as uneven shoulders, an uneven waist, or hips that appear at different heights. The Adam’s forward bend test is often used, where individuals bend forward from the waist with arms hanging down and legs straight. This position makes any spine abnormalities more visible.

If a curved spine is suspected, imaging tests are used to confirm the diagnosis. X-rays are the main tool for identifying and measuring the curve of the spine. They provide clear images that help doctors determine the angle of the curve, which is important for planning treatment and monitoring changes over time.

For more detailed images, especially before surgery, CT scans can be used. These scans give a three-dimensional view of the spine, helping doctors to:

• determine the exact severity and location of the curve
• understand what might be causing the scoliosis
• see how the curve affects other parts of the body
• monitor the condition over time.

With all this information, medical teams can create personalized treatment plans that best meet each patient’s needs.

What are the treatment options for scoliosis?

The treatment options for scoliosis vary depending on several factors, including:

• Severity of the curve: The degree of curvature plays a significant role in determining the treatment approach. Mild curves may not require treatment, moderate curves may benefit from bracing, and severe curves may necessitate surgery.
• Age and maturity of the individual: Treatment options can differ for children and adolescents whose bones are still growing compared to adults whose bones have matured.
• Overall health and medical history: The individual's general health and any underlying medical issues are considered when choosing the most suitable treatment.

Common treatment options for scoliosis include the following.

Observation

For mild curves (usually less than 25 degrees), doctors may recommend regular checkups to monitor the progression of the curve. This approach is often used in children and adolescents who are still growing, as the curve may stabilize or even improve on its own.

Bracing

Bracing is a non-surgical option used to slow down or prevent the progression of moderate curves (typically 25-45 degrees) in children and adolescents. Braces work by applying gentle pressure to the spine, encouraging it to grow straighter. There are different types of braces available, and the choice depends on the individual's needs and preferences.

Surgery

Surgery is usually only required for severe curves (greater than 45 degrees) or cases where bracing is ineffective. The most common surgical procedure for scoliosis is spinal fusion, where the surgeon joins two or more vertebrae together to prevent further curvature. In some cases, metal rods, hooks, screws, or wires may be used to support the spine during the healing process.

Physical therapy

While physical therapy alone cannot correct scoliosis, it can be used alongside other treatments to manage symptoms and improve flexibility and overall wellbeing.

What are the treatment options for ankylosing spondylitis?

Managing ankylosing spondylitis requires a comprehensive, multidisciplinary approach. This can include retraining the body’s response to pain, engaging in physical therapy and exercise, and using medications for short-term pain relief.

Additionally, mind and body practices such as counseling, stress reduction techniques, and improving sleep quality can significantly aid in pain management. These methods can also help relieve pain effectively.

Medication

While medication can be part of your overall pain management plan, it is important not to rely on it as the main treatment. Think of medication as a tool that helps you use other effective pain management strategies to improve your condition. These strategies may include education, lifestyle changes, and psychological support.

Common medications prescribed for ankylosing spondylitis include:

• over-the-counter medications like aspirin and ibuprofen
• nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen and indomethacin, which help manage pain and reduce inflammation
• disease-modifying antirheumatic drugs (DMARDs) like sulfasalazine, which help manage inflammation and slow disease progression.

Your doctor is the best person to talk to about which medications or pain relievers may be suitable for your individual situation.

Recent studies suggest that tumor necrosis factor (TNF) inhibitors may not be as effective in treating neuropathic pain in AS patients, though they do help with inflammatory pain. This shows the need for personalized treatment plans that address both pain types.

Physical therapy & exercise

Physical therapy and exercise play a crucial role in managing ankylosing spondylitis. These activities can help reduce pain, maintain joint flexibility, and improve movement while strengthening muscles. An effective exercise plan for those with AS includes:

• cardiovascular exercises to improve heart health
• stretching routines to increase range of motion
• strength-building workouts
• balance-improving activities.

Flexibility exercises are especially important. They help prevent spinal stiffness and keep joints fluid, making movement easier.

Aquatic activities, like water aerobics, can be very beneficial. They ease joint discomfort and improve agility. Warm water hydrotherapy can also reduce pain and make joints more flexible.

Movement and exercise can also reduce pain, boost mood and energy levels, and improve sleep quality. You can adjust activities to fit your limitations and symptoms. It doesn't have to be formal exercise either. Any active hobbies count, including yoga, dancing, or even gardening.

Two key tips are to start slowly and be kind to yourself. Begin with small, low-impact exercises and gradually increase intensity and duration. This allows your body to adapt safely. Practicing self-compassion helps you face challenges with resilience and confidence.

Retraining your pain response

To retrain your pain response, it's important to understand that pain is not just a physical sensation. It is influenced by many factors, including your body, mind, and environment.

First, identify what triggers your pain. These triggers can be stress, certain beliefs, or behaviors. Once you know your triggers, you can start to change them. For example, you can improve your nutrition, get better sleep, and increase your physical activity. Techniques based on neuroplasticity can also help. These methods change how your brain reacts to pain triggers. With practice and dedication, you can gradually reduce the intensity and impact of your chronic pain.

Here are some methods you can use to start this process.

Stress management

Stress hormones, such as cortisol, can amplify your body's pain response, making discomfort worse. While it may not be possible to avoid stress entirely, there are effective ways to manage it and reduce your body's reaction to stressful situations. These methods include cognitive behavioral therapy (CBT), mindfulness meditation, relaxation practices, and seeking emotional and social support from friends, a therapist, or a community.

Sleep quality

Sleep plays a crucial role in managing ankylosing spondylitis. It is an important part of self-care strategies for reducing pain. Poor sleep can make symptoms worse, and symptoms can cause sleep problems.

Improving your sleep can help relieve many ankylosing spondylitis symptoms, including pain. Here are some tips for better sleep:

• Keep a regular sleep schedule. Go to bed and wake up at the same times every day. Aim for eight hours of sleep each night.
• Limit naps during the day. If you need to nap, keep it short to avoid disrupting your nighttime sleep.
• Stay active during the day. Physical activity can help you fall asleep more easily.
• Reduce screen time before bed. This helps create a better environment for sleep.
• Make your sleep space dark and quiet. This supports uninterrupted sleep.
• Be careful with caffeine. Avoid it in the afternoon and evening as it can stay in your system and affect your sleep.
• Avoid large meals and alcohol close to bedtime. This can improve your sleep quality.
• Use various forms of rest for your heart, body, and mind. This complements good sleep habits and helps manage ankylosing spondylitis symptoms effectively.