Spine In Patients Research Articles

Bilateral ultrasound-guided erector spinae plane block for postoperative pain relief in major traumatic spine surgery: A randomized controlled trial.

Spine fixation surgery for traumatic vertebral fractures is associated with severe pain and is often difficult to control. Traditionally systemic opioids have been the mainstay of analgesia for these procedures, which can lead to hyperalgesia, nausea, ileus, sedation, cognitive impairment, dependence, etc., limiting usage of opioids. The Erector spinae plane block (ESPB) is a novel ultrasound-guided procedure with easily identifiable sonoanatomy. We hypothesized that a multimodal approach involving ESPB to a conventional analgesic regimen with local infiltration for patients undergoing major traumatic spine surgeries might provide better perioperative analgesia and reduce the need for postoperative opioid requirements. A randomized control prospective trial was conducted on 34 ASA grade I -II patients aged 18 to 65 years who were scheduled to undergo elective posterior spine fixation surgery with ASIA B to E after traumatic spine fracture under general anesthesia. Patients were randomized to Group A which included patients who received general anesthesia with ESPB, and Group B, or the control group, included patients who received general anesthesia with systemic analgesics and postoperative local infiltration without ESPB. Intraoperative total fentanyl consumption, VAS score at 0, 3, 6, 12, 18, and 24 hours, time to activate patient-controlled analgesia (PCA) pump, total morphine consumption, and opioid-related side effects were monitored and compared in both groups. Postoperative PCA morphine consumption was significantly lower in group A patients who received ESPB than those in the control group (17.06 ± 9.59 vs 37.82 ± 9.88 P value = <0.0001). VAS scores at rest and movement at 0, 3, 6, 9, 12, 18, and 24 hours were significantly lower (P value = 0.05) in the ESPB group compared with the control group at all time points. Bilateral ultrasound-guided Erector spinae plane block, when administered in traumatic spine patients undergoing spine fixation surgery, provides better analgesia with statistically decreased VAS scores and less postoperative opioid requirement.

Commentary: Postoperative Use and Early Discontinuation of Intravenous Lidocaine in Spine Patients

Commentary: Postoperative Use and Early Discontinuation of Intravenous Lidocaine in Spine Patients

The Role of L1PA in Patient-reported Outcomes in Patients Undergoing Single-level Lumbar Fusion for Degenerative Spondylolisthesis.

Retrospective cohort study. To determine whether the L1 pelvic angle (L1PA) can be used to predict quality of life outcomes for adults one year after L4-L5 fusion to treat degenerative spondylolisthesis. L1PA is beneficial in the evaluation of preoperative and postoperative quality of life outcomes in patients undergoing surgery for spinal deformity. No studies have examined its utility in surgical patients with degenerative spinal disease. Patients undergoing L4-L5 posterolateral decompression and fusion or transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis were grouped by preoperative and postoperative L1PA, and further stratified by cut offs of >7.2° and <7.2° based on previous literature. We also stratified patients by presence of an ideal calculated L1PA, defined as (0.5×Pelvic incidence) -21 +/-5°, as proposed by prior literature. Preoperative, one-year postoperative and Δ (postoperative minus preoperative) patient-reported outcome measures (PROMs) and radiographic measurements were collected. Twenty-four patients were identified with preoperative L1PAs <7.2° and 132 with L1PAs >7.2°. Eighteen patients were identified with postoperative L1PAs <7.2° and 138 with L1PAs>7.2°. Sixty-five and fifty-seven patients were identified as having ideal calculated preoperative and postoperative L1PAs, respectively. When using absolute cutoffs, L1PA correlated with pelvic tilt, pelvic incidence, and pelvic incidence-lumbar lordosis mismatch (PI-LL). When using calculated L1PAs, L1PA correlated with lumbar lordosis, PI-LL, pelvic tilt and sacral slope. With respect to PROMs, no statistically significant differences existed between cohorts both preoperatively and at one-year postoperatively on either univariate and multivariate analyses. L1PA may be a helpful radiographic consideration that translates to clinically relevant outcomes in spinal deformity. However, it does not appear as predictive of patient outcomes after single-level fusion for patients with L4-L5 degenerative spondylolisthesis. Further studies are warranted to investigate the role of L1PA in degenerative spine patients.

Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey

ObjectiveDevelop a process map of when patients learn about their proposed surgery and what resources patients use to educate themselves.DesignA mixed methods design, combining semistructured stakeholder interviews, quantitative validation using...

Pre-operative carbohydrate drink in pediatric spine fusion: randomized control trial.

As rapid discharge protocols for pediatric spine fusion shorten stays, gastrointestinal (GI) complications are uncovered and cause delays in discharge. A pre-operative carbohydrate (CHO) drink has been shown to improve perioperative GI symptoms and functional return but has not been examined in pediatric spine patients. We aimed to determine if a preoperative CHO drink is safe in pediatric spine fusion patients, and if it improves their comfort scores and return of bowel function. We prospectively randomized ASA-1 and -2 pediatric spine fusion patients to either a pre-anesthesia carbohydrate drink 2h prior to surgery or to a control group (standard 8h NPO), blinded to surgical team. We documented time to return to flatus, bowel movement, GI symptoms, and comfort scores for 72h post-operatively or until discharge. 62 patients were randomized. There was no significant differences between the groups' pre-operative characteristics, surgical details, nor post-operative morphine dose equivalents, except for EBL (405cc control, 340cc CHO drink, p = 0.044). There were no perioperative complications related to ingestion of the CHO drink. CHO group had a positive trend for earlier return of flatus (21% vs. 3% return at 12h), and comfort scores for anxiety and abdominal pain, but no statistically significant differences. There was no difference in length of stay or time to first bowel movement. There were no complications related to ingestion of a CHO drink 2h prior to pediatric spinal fusion surgery. Further studies are needed to develop a study blinded to the participants with larger sample size. Level of evidenceI.

Pushing the Limits of Minimally Invasive Spine Surgery-From Preoperative to Intraoperative to Postoperative Management.

The introduction of minimally invasive surgery ushered in a new era of spine surgery by minimizing the undue iatrogenic injury, recovery time, and blood loss, among other complications, of traditional open procedures. Over time, technological advancements have further refined the care of the operative minimally invasive spine patient. Moreover, pre-, and postoperative care have also undergone significant change by way of artificial intelligence risk stratification, advanced imaging for surgical planning and patient selection, postoperative recovery pathways, and digital health solutions. Despite these advancements, challenges persist necessitating ongoing research and collaboration to further optimize patient care in minimally invasive spine surgery.

286 Bone Quality as Measured by Hounsfield Units More Accurately Predicts Proximal Junctional Kyphosis Than Vertebral Bone Quality Following Long-segment Thoracolumbar Fusion

INTRODUCTION: Both Hounsfield units (HU) on computed tomography and Vertebral Bone Quality (VBQ) score on MRI have been advanced as means of assessing underlying bone quality and predicting mechanical complications amongst spine patients. METHODS: Patients = 50 with =12-month follow-up following long-segment thoracolumbar fusion were included. Bone quality around the upper instrumented vertebrae (UIV) was measured using HU on preoperative CT and VBQ on preoperative MRI. Spinopelvic parameters were also measured. PJK was defined as a change of =10° in the Cobb angle between the cephalad endplate of UIV+2 and caudal endplate of UIV. Univariable analysis to identify predictors of the occurrence of PJK and survival analyses with Kaplan-Meier method and Cox regression were performed to identify predictors of time to PJK. Sensitivity analyses showed thresholds of HU &lt; 164 and VBQ &gt; 2.7 to be most predictive for PJK. RESULTS: Seventy-six patients (66.0 ± 7.0 yr; 27.6% male) were identified, with 15 suffering PJK. On univariable analyses PJK was predicted by high postoperative pelvic tilt (p = 0.038), postoperative T1-pelvic angle (p=0.041), and postoperative PI-LL mismatch (p = 0.028). On multivariable survival analysis, bone quality, as assessed by average HU of the UIV and UIV+1 was the only significant predictor of time to PJK (OR=3.053; 95%CI [1.032, 9.032]; p = 0.044). VBQ measured using the UIV, UIV+1, UIV+2, and UIV-1 vertebrae approached, but did not reach significance (2.913; [0.797, 10.646]; 0.106). CONCLUSIONS: In larger cohorts, VBQ may prove to be a significant predictor of PJK following long-segment thoracolumbar fusion. However, it has less predictive power than Hounsfield units on CT, suggesting preoperative workup for patients undergoing long-segment thoracolumbar fusion may benefit from CT versus MRI alone to identify those at increased risk of PJK.

Disparities in Patient-reported Outcome Measure Completion Rates and Baseline Function in Newly Presenting Spine Patients.

Retrospective review. The purpose of this study was to evaluate disparities in patient-reported outcome measures (PROM) completion rates and baseline function scores among newly presenting spine patients. Prior studies have demonstrated that minority patients and those of low socioeconomic status may present with worse physical and mental health on PROMs. As PROMs are increasingly used in clinical care, research, and health policy, accurate assessment of health status among populations relies on the successful completion of PROM instruments. A retrospective review of 10,803 consecutive new patients presenting to a single multidisciplinary spine clinic from June 2020 to September 2022 was performed. Univariate statistics were performed to compare demographics between patients who did and did not complete PROMs. Multivariable analysis was used to compare PROM instrument completion rates by race, ethnicity, and Social Vulnerability Index (SVI) and baseline scores among responders. A total of 68.4% of patients completed PROMs at the first clinic visit. After adjusting for age, sex, body mass index, and diagnosis type, patients of non-White race (OR=0.661, 95% CI=0.599-0.729, P <0.001), Hispanic ethnicity (OR=0.569, 95% CI=0.448-0.721, P <0.001), and increased social vulnerability (OR=0.608, 95% CI=0.511-0.723, P <0.001) were less likely to complete PROMs. In the multivariable models, patients of non-White race reported lower levels of physical function (β=-6.5, 95% CI=-12.4 to -0.6, P =0.032) and higher levels of pain intensity (β=0.6, 95% CI=0.2-1.0, P =0.005). Hispanic ethnicity (β=1.5, 95% CI=0.5-2.5, P =0.004) and increased social vulnerability (β=1.1, 95% CI=0.4-1.8, P =0.002) were each associated with increased pain intensity. Among newly presenting spine patients, those of non-White race, Hispanic ethnicity, and with increased social vulnerability were less likely to complete PROMs. As these subpopulations also reported worse physical function or pain intensity, additional strategies are needed to better capture patient-reported health status to avoid bias in clinical care, outcomes research, and health policy. 4.

A decade of experience in over 300 surgically treated spine patients with long-term oral anticoagulation: a propensity scorematched cohort study.

The aim of this study was to investigate the risks and outcomes of patients with long-term oral anticoagulation (OAC) undergoing spine surgery. All patients on long-term OAC who underwent spine surgery between 01/2005 and 06/2015 were included. Data were prospectively collected within our in-house Spine Surgery registry and retrospectively supplemented with patient chart and administrative database information. A 1:1 propensity score-matched group of patients without OAC from the same time interval served as control. Primary outcomes were post-operative bleeding, wound complications and thromboembolic events up to 90days post-surgery. Secondary outcomes included intraoperative blood loss, length of hospital stay, death and 3-month post-operative patient-rated outcomes. In comparison with the control group, patients with OAC (n = 332) had a 3.4-fold (95%CI 1.3-9.0) higher risk for post-operative bleeding, whereas the risks for wound complications and thromboembolic events were comparable between groups. The higher bleeding risk was driven by a higher rate of extraspinal haematomas (3.3% vs. 0.6%; p = 0.001), while there was no difference in epidural haematomas and haematoma evacuations. Risk factors for adverse events among patients with OAC were mechanical heart valves, posterior neck surgery, blood loss > 1000mL, age, female sex, BMI > 30kg/m2 and post-operative PTT levels. At 3-month follow-up, most patients reported favourable outcomes with no difference between groups. Although OAC patients have a higher risk for complications after spine surgery, the risk for major events is low and patients benefit similarly from surgery.

Objective Gait Analysis Using a Single-Point Wearable Sensor to Assess Lumbar Spine Patients Pre- and Postoperatively

Background: Outcome measurement in lumbar surgery is traditionally performed using patient questionnaires that may be limited by subjectivity. Objective gait analysis may supplement patient assessment but must be clinically viable. We assessed gait metrics in lumbar spine patients pre- and postoperatively using a small and lightweight wearable sensor. Methods: This was a prospective observational study with intervention including 12 patients undergoing lumbar spine surgery and 24 healthy controls matched based on age and sex. All the subjects underwent gait analysis using the single-point wearable MetaMotionC sensor. The lumbar spine patients also completed traditional patient questionnaires including the Oswestry Disability Index (ODI). Results: The ODI score significantly improved in the patients from the baseline to six weeks postoperatively (42.4 to 22.8; p = 0.01). Simultaneously, the patients demonstrated significant improvements in gait asymmetry (asymmetry in step length, swing time, single support time, and double support time, by 17.4–60.3%; p ≤ 0.039) and variability (variability in gait velocity, step time, step length, stance time, swing time, single support time, and double support time, by 21.0–65.8%; p ≤ 0.023). After surgery, changes in most spatiotemporal (gait velocity, step length, stance time, swing time, and single limb support time) and asymmetry (asymmetry in step time, stance time, swing time, and single limb support time) metrics correlated strongly (magnitude of r = 0.581–0.914) and significantly (p ≤ 0.037) with changes in the ODI. Conclusions: Gait analysis using a single-point wearable sensor can demonstrate objective evidence of recovery in lumbar spine patients after surgery. This may be used as a routine pre- and postoperative assessment during scheduled visits to the clinic.

Depression Screening in Pediatric Orthopedic Surgery Clinics and Identifying Patients At-Risk.

Up to 25% of youth experience a depressive episode by 18 years of age, leading the US Preventive Services Task Force to recommend depression screening within this population. This study aimed to understand the prevalence of depression identified within pediatric orthopedic clinics compared with primary care clinics after the implementation of a screening program and present data on the prevalence of moderate-severe depression across specific pediatric orthopedic clinics, characterizing and identifying specific populations at higher risk. A retrospective review was performed to identify all patients screened using the 2-item and 9-item versions of the Patient Health Questionnaire (PHQ-2/PHQ-9) and the Columbia-Suicide Severity Rating Scale over a 2-year period (October 2018 to January 2021) within pediatric primary care and orthopaedic clinics. Demographic and clinical characteristics were collected. Statistical analysis was performed to compare scores between orthopedic and primary care clinics, as well as between the different pediatric orthopedic subspecialties and included χ 2 test, ANOVA, and logistic regression. There were 32,787 unique adolescent patients screened in primary care clinics, with an additional 14,078 unique adolescent patients screened in orthopaedic clinics, leading to a 30% increase in the overall number of patients receiving depression screening. 5.2% of patients in primary care pediatric clinics screened positive for moderate-severe depression versus 2.0% in pediatric orthopaedic clinics ( P <0.001). 2.7% of primary care patients were at risk of self-harm compared with 0.8% of orthopedic patients ( P <0.001). Within orthopaedic subspecialty clinics, the spine patients were at the highest risk of moderate-severe depression (3.5%), significantly higher than both the sports (1.4%, P =0.006) and patients with acute fracture (1.3%, P <0.001). This study demonstrates the high incidence of patients screening positive for depression in pediatric and adolescent orthopaedic clinics. By identifying high-risk clinics and patient groups, health care systems can apply a more practical approach and appropriately deploy behavioral health specialists for timely counseling and treatment discussions. Level-III.

Auto-CA: Automated Cobb Angle Measurement Based on Vertebrae Detection for Assessment of Spinal Curvature Deformity.

An accurate identification and localization of vertebrae in X-ray images can assist doctors in measuring Cobb angles for treating patients with adolescent idiopathic scoliosis. It is useful for clinical decision support systems for diagnosis, surgery planning, and spinal health analysis. Currently, publicly available annotated datasets on spinal vertebrae are small, making deep-learning-based detection methods that are highly data-dependent less accurate. In this article, we propose an algorithm based on convolutional neural networks that can be trained to detect vertebrae from a small set of images. This method can display critical information on a patient's spine, display vertebrae and their labels on the thoracic and lumbar, calculate the Cobb angle, and evaluate the severity of spinal deformities. The proposed achieved an average accuracy of 0.958 and 0.962 for classifying spinal deformities (i.e., C-shaped, S-shaped type 1, and S-shaped type 2) and severity of Cobb angle (i.e., normal, mild, moderate, and severe), respectively. The Cobb angle measurement had a median difference of less than 5° from the ground-truth with SMAPE of 5.27% and an error on landmark detection of 19.73. In addition, Lenke classification is used to analyze spinal deformities as types A, B, and C, which have an average accuracy of 0.924. Physicians can use the proposed system in clinical practice by providing X-ray images via the user interface.

Superficial Femoral Artery Atherosclerosis Masquerading as Sciatica: Diagnosis and Conservative Management – A Case Report

BACKGROUND: Often misdiagnosed as sciatica, vascular disorders such as peripheral arterial disease (PAD) can lead to a decreased quality of life. CASE PRESENTATION: The patient was a 44-year-old female referred to physical therapy with diagnosis of right-sided sciatica and L5-S1 degenerative disc disease, reporting right hip pain radiating into the thigh and foot, and worsening calf cramping. Based on inconsistent exam findings with lumbar spine imaging, patient comorbidities, and medication review, there was suspicion of PAD. The patient was referred to vascular surgery with recommendation of arterial ultrasound evaluation per American College of Radiology imaging guidelines. OUTCOME AND FOLLOW-UP: Arterial duplex revealed moderate arterial insufficiency with right distal superficial femoral artery occlusion. Patient underwent a 12-week supervised exercise program using the Gardner-Skinner Protocol for conservative management. DISCUSSION: Recognizing clinical presentation of arterial pathology, knowledge of imaging guidelines, and interdisciplinary care are essential for optimal management of PAD, particularly in cases with atypical risk factors. JOSPT Cases 2024;4(1):22-29. Epub 8 January 2024. doi:10.2519/josptcases.2024.12102

The Effect of Marijuana on Postoperative Spine Patients' Emergency Department Visits, Readmission Rates, and Opioid Consumption.

To compare postoperative opioid consumption with patients who tested negative for tetrahydrocannabinol (THC) preoperatively with those who were THC-positive and patients who were positive for THC and any other drug and to compare 90-day rates of postoperative emergency department (ED) visits and 90-day readmission rates, using morphine milligram equivalents (MMEs), for those three patient populations. Three patient groups were confirmed with preoperative urine drug screens. Chart reviews were conducted to determine whether there was an ED visit or hospital readmission 90 days from the index procedure. MMEs were calculated for all patients. There were a total of 252 patients in the THC-negative control group, 54 in the THC-positive group, and 47 in the THC-and-opioid-positive group. The 90-day ED visit and 90-day readmission rates were not statistically significant among the groups. Both the multidrug and THC-only-positive patients showed a higher 90-day MME compared with the control patients. Our study demonstrates that THC used may increase opioid consumption. The THC patients to be cautious toward are the multidrug user. Although not statistically significant, multidrug patients were noted for a trend toward increased ED visits and readmissions.

Healthcare provider perspectives on integrating a comprehensive spine care model in an academic health system: a cross-sectional survey

BackgroundHealthcare systems (HCS) are challenged in adopting and sustaining comprehensive approaches to spine care that require coordination and collaboration among multiple service units. The integration of clinicians who provide first line, evidence-based, non-pharmacological therapies further complicates adoption of these care pathways. This cross-sectional study explored clinician perceptions about the integration of guideline-concordant care and optimal spine care workforce requirements within an academic HCS.MethodsSpine care clinicians from Duke University Health System (DUHS) completed a 26-item online survey via Qualtrics on barriers and facilitators to delivering guideline concordant care for low back pain patients. Data analysis included descriptive statistics and qualitative content analysis.ResultsA total of 27 clinicians (57% response) responded to one or more items on the questionnaire, with 23 completing the majority of questions. Respondents reported that guidelines were implementable within DUHS, but no spine care guideline was used consistently across provider types. Guideline access and integration with electronic records were barriers to use. Respondents (81%) agreed most patients would benefit from non-pharmacological therapies such as physical therapy or chiropractic before receiving specialty referrals. Providers perceived spine patients expected diagnostic imaging (81%) and medication (70%) over non-pharmacological therapies. Providers agreed that receiving imaging (63%) and opioids (59%) benchmarks could be helpful but might not change their ordering practice, even if nudged by best practice advisories. Participants felt that an optimal spine care workforce would require more chiropractors and primary care providers and fewer neurosurgeons and orthopedists. In qualitative responses, respondents emphasized the following barriers to guideline-concordant care implementation: patient expectations, provider confidence with referral pathways, timely access, and the appropriate role of spine surgery.ConclusionsSpine care clinicians had positive support for current tenets of guideline-concordant spine care for low back pain patients. However, significant barriers to implementation were identified, including mixed opinions about integration of non-pharmacological therapies, referral pathways, and best practices for imaging and opioid use.

The subjective and objective quality of life score (SOQOLTM) for the quantification of general health status: a preliminary study with initial normative population values

BackgroundEstablished health-related quality of life scores do not consider both subjective and objective indices of health. We propose the subjective and objective quality of life score (SOQOL) for the comprehensive assessment of health-related quality of life and aim to provide normative population data. The SOQOL is compatible with smartphone applications, allowing widespread use on a global scale.MethodsNormative SOQOL population data was sourced from pre-existing datasets on the EQ-5D-5L, daily step count, and walking speed. Normative values were calculated using weighted grand means. We trialled the SOQOL in a group of five patients presenting to a spinal neurosurgery clinic.ResultsSOQOL scores decreased with age, and women had lower scores in every age group. In our case series, the spine patients with the biggest SOQOL deficit compared to age- and sex-matched population averages were found to be surgical while the rest were non-surgical.ConclusionsThe SOQOL shows promise as a simple and effective scoring tool that is compatible with smartphones, potentially useful for screening in primary and specialized care settings, and for assessment following healthcare interventions. This study, however, is preliminary, and the findings are primarily suggestive. They underline the necessity for future, more comprehensive studies to validate and expand upon these initial observations. The conclusion of both this abstract and the full paper will clearly state these limitations and the preliminary nature of the study.

Spine Surgeon Health and Well-being

Abstract As spine surgeons continue to strive for high-quality patient care in an ever-changing health care environment, their individual health can often be put on the back burner. Under the stress of caring for and operating on the spine patient, surgeons must juggle additional hardships in the form of occupational exposures such as intraoperative radiation, degenerative conditions secondary to ergonomics and the inherent physical tax of spine surgery, and an increasing incidence of mental health disorders. In this review, we discuss the current body of literature as it relates to physical, mental, and occupational tolls placed on surgeons.

Application Effect Analysis of Multidisciplinary Collaboration in Pain Management of Home Lumbar Spine Patients

Application Effect Analysis of Multidisciplinary Collaboration in Pain Management of Home Lumbar Spine Patients

UNEXPLAINED UNILATERAL LOWER LIMB NEUROLOGICAL DEFICITS AFTER POSTERIOR SPINAL DECOMPRESSION AND FUSION FOR DEGENERATIVE LUMBAR SPONDYLOLISTHESIS

The observational data from the Spine Patient Outcomes Research Trial (SPORT) confirm the superiority of surgical over conservative management of symptomatic degenerative spondylolisthesis. The most common reported neurologic complications after lumbar posterior decompression and fusion are implant malposition, contralateral foraminal stenosis, hematoma/seroma, arachnoiditis, and nerve root oedema or vascular underlying causes. The current study reported that the patient developed unexpected left side neurological deficit after conventional lumbar posterior spinal decompression surgery for degenerative spondylolisthesis. No intraoperative dural insult. The computer topography (CT) scan and magnetic resonance imaging (MRI) of the spine after index surgery show adequate canal and foraminal decompression. No hardware-related complications or compressive hematoma could explain the patient’s symptoms. The patient recovered completely after removing the redundant posterolateral bone graft. The theory behind that is aggressive posterolateral dissection over the transverse process and abundant application of the bone graft might compress or injure the lumbar plexus. So, we suggested a delicate dissection posterolaterally and only a reasonable amount of bone graft could be applied to prevent such a devastating neurological complication.

Co-Occurrence of Behçet's Disease and Ankylosing Spondylitis: A Rare Case Report

Introduction Behçet's Disease and Ankylosing Spondylitis are two distinct inflammatory conditions that have rarely been reported to coexist. This study reports a 41-year-old male patient with the co-occurrence of both conditions. Case presentation A 41-year-old male presented with chronic lower back pain for a period of 20 years. He also had left eye redness and painful oral ulcers. On physical examination, there were oral lesions and left eye redness (uveitis), and the patient's spine exhibited restricted mobility. Magnetic Resonance Imaging of the sacroiliac joint showed sacroiliacis affecting both sacroiliac joints. Hence, the patient was diagnosed as a case of mixed Behcet's disease and ankylosing spondylitis. The patient was managed with Azathioprine (Imuran) tablet (50 mg) twice daily, Colchicine tablet (1 mg) once daily, Topical steroid and Ulciguard mouth spray, Prednisolone tablet (5 mg) once daily, calcium and vitamin D3 tablet once daily, steroid eye drops, nonsteroidal anti-inflammatory drugs for 2 weeks. As a result, the patient achieved a dramatic response with all the symptoms resolved. Conclusion Behçet's disease and ankylosing spondylitis can coexist with overlapping presentations, making their clinical diagnosis challenging.