By Sharron Sussman
When Mr. Leonard was admitted to the hospital, he couldn't meet my eyes. He wasn't shy--he simply couldn't raise his head. His spine was curved so far forward that when he sat, all I could see of him was the top of his head.
Ankylosing spondylitis, the condition that had brought him to this state, sometimes leaves its victims unable to eat or speak normally. In these patients, the stiffly flexed spine pins the chin and lower jaw firmly against the breastbone. The condition, a kind of arthritis that primarily affects the spine and sacroiliac joints, starts insidiously in young adulthood, and the pain is usually mild. But when the wave of inflammation has passed, the joints stiffen permanently, and the ligaments calcify and turn to bone. The once flexible spine becomes, in effect, a single bone from skull to pelvis.
If the condition is diagnosed early, the patient can do exercises to keep the spine upright. Exercises can't keep the joints from stiffening, but they can keep the spine from curving forward severely.
Mr. Leonard's stoop hadn't been diagnosed until his mid-forties, when a sharp-eyed internist had spotted the strangely segmented "bamboo" spine typical of ankylosing spondylitis on a chest X-ray. Mr. Leonard's forward curve was fixed at about 40 degrees beyond the upper limit of normal. It was far too late to alter the deformity with exercises or even with bracing. Still, Mr. Leonard was doing well. He was married, worked as a draftsman, and hiked on weekends. Active treatment had not been necessary.
