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A 66-year-old man had progressive reduction of global spine movement for more than two decades that eventually resulted in complete spinal immobility. Extensive calcification of the intervertebral ligaments, bilateral ossification of the outer layer of the annulus fibrosis (forming bony bridges called marginal syndesmophytes), and apophyseal joint ankyloses all gave the appearance of a bamboo spine, as shown in Panel A. Bilateral symmetric sacroiliitis, caused initially by erosive disease and subsequently by bony ankylosis, can be seen as indistinct sacroiliac joints. A left hip excision arthroplasty had been performed previously for severe joint disease. The right femoral head and acetabulum show avascular necrosis, possibly due to prolonged oral intake of traditional Chinese medicine containing glucocorticoid-like compounds. Naproxen was effective in alleviating joint pain. Spinal ankylosis and kyphoscoliosis may cause restrictive pulmonary impairment. Thoracic-spine ankylosis is shown in Panel B, which also shows an endotracheal tube, which had to be inserted endoscopically because of spinal rigidity, and a nasogastric tube, the tip of which is in the stomach. Five years after presenting with advanced ankylosing spondylitis, the patient died of respiratory failure and septic shock related to severe pneumonia.
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