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Out-of-state? Free MRI review + telehealth consult before you travel4.9 ★ · 619 Google reviewsBoard-certified — American Board of Orthopaedic SurgeryMinimally invasive, same-day spine surgery in Beverly HillsCall (424) 217-7463
Spondylitis is inflammation of the spinal joints — an autoimmune form of arthritis, not simple wear and tear — and it is managed differently because of that.
Spondylitis means inflammation of the joints of the spine. Unlike osteoarthritis, which comes from mechanical wear, spondylitis is driven by the immune system attacking the joints and the places where ligaments attach to bone. The most familiar form is ankylosing spondylitis, a type of inflammatory arthritis that typically begins in the sacroiliac joints where the spine meets the pelvis.
Because it is inflammatory, spondylitis behaves differently from a worn disc: the stiffness is usually worst in the morning or after rest and eases with movement, and it often begins before age 40. Over years, ongoing inflammation can cause new bone to form and vertebrae to fuse together, which stiffens the spine. Recognizing that this is a systemic inflammatory disease — not just a back problem — shapes the whole approach to care.
Unlike osteoarthritis which develops in people over 40, spondylitis occurs in patients ranging from 17 to 45. Spondylitis begins in early adulthood and is more prevalent among men than women.
✓Deep back and buttock stiffness that is worst in the morning or after rest
✓Stiffness that improves with movement and exercise rather than rest
✓Gradual onset of symptoms, often before age 40
✓Pain in the sacroiliac joints where the spine meets the pelvis
✓Reduced spinal flexibility and, over time, a stooped posture
✓Fatigue, and sometimes eye inflammation or other whole-body symptoms
Spondylitis is challenging to diagnose because its symptoms are similar to injuries to the spine caused by trauma or sports activities.
It is essential for the patient to clearly define the locations of the symptoms to help diagnose the condition. Other areas of concern include:
Pain at the back of your heels
Soreness of the ribs or around the breastbone
Hip and shoulder pain
Waking late at night with hip, shoulder or back pain
Ankylosing spondylitis should not be ignored. In its early stages, it can thin the patient’s bones and cause vertebrae to weaken and crumble. With time, a patient with spondylitis can develop a stooped posture. The systemic disease can crack vertebrae and damage nerves. It can also attack the aorta of the heart and deform the valve.
Spondylitis and the Genetic Factor
An autoimmune, inflammatory process rather than mechanical wear
A strong genetic component, often linked to the HLA-B27 gene
Inflammation at entheses, where ligaments and tendons attach to bone
Family history of ankylosing spondylitis or related conditions
Why Spondylitis Is Challenging to Diagnose
Diagnosing spondylitis relies on the pattern — inflammatory back pain that improves with activity, an early age of onset, and involvement of the sacroiliac joints. Imaging such as X-ray or MRI can show inflammation and, later, new bone formation, and bloodwork including the HLA-B27 marker adds information. Because this is a rheumatologic disease, Dr. Melamed's role is often to coordinate with a rheumatologist and to address the structural or nerve-compression problems that inflammation can cause over time.
How do you treat spondylitis?
The foundation of care for spondylitis is medical and is led with rheumatology: anti-inflammatory medication, and for many patients biologic therapies that target the inflammation directly, along with a consistent exercise and posture program that keeps the spine mobile. This is not a condition that surgery cures.
Surgery has a specific, limited role. When years of inflammation have caused nerve or spinal cord compression, a significant spinal fracture, or a deformity that impairs the ability to stand and look ahead, Dr. Melamed evaluates whether a decompression or a carefully planned correction would help. He favors the least-invasive approach appropriate for the situation and is candid that operating on an inflamed, sometimes brittle spine calls for careful planning and honest expectations.
Spondylitis is a systemic inflammatory disease that can be managed but not cured. It is paramount that ankylosing spondylitis is treated before damage to the spine, joints and heart is irreversible. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAID) such as aspirin, naproxen and ibuprofen will reduce pain and inflammation.
If the NSAIDs are not effective, biological medications such as a tumor necrosis factor (TNF) blocker, or interleukin 17 have been prescribed to manage the disease.
Yoga, Pilates and Tai Chi may also help the patient improve mobility, reduce stress and enhance the immune system.
No. Spondylitis is inflammatory arthritis driven by the immune system, while osteoarthritis of the spine comes from mechanical wear. The clue is the pattern: inflammatory stiffness is worst after rest and eases with movement, whereas mechanical pain usually worsens with activity. The treatments differ because the underlying cause differs.
Can surgery cure ankylosing spondylitis?
No. The inflammation itself is managed medically, usually with a rheumatologist and often with biologic medications. Surgery is reserved for specific structural consequences of the disease — such as nerve compression, a fracture, or a fixed deformity — rather than for the arthritis as a whole.
Why does exercise help my stiffness?
Inflammatory spinal stiffness typically eases with movement, so a regular program of stretching, posture work, and activity is one of the most effective things you can do. It helps preserve mobility and posture over the long term, which is why it is a core part of managing spondylitis.
When should I see a spine surgeon rather than only a rheumatologist?
Rheumatology leads the day-to-day management. A surgical evaluation is worthwhile if you develop new leg or arm weakness, numbness, a suspected fracture, or a posture that makes it hard to stand upright and look ahead — signs that inflammation has caused a structural problem worth addressing.
