If you have lower back or neck pain with ankylosing spondylitis (AS), you may wonder, “Can you have spinal stenosis and ankylosing spondylitis?” The answer is yes. These two different conditions can happen at the same time.

Ankylosing spondylitis is a form of arthritis that affects the bones in the spine, also known as vertebrae. It’s an autoimmune disease caused by an overactive immune system creating inflammation. Eventually, AS can wear down the bones, leading to extra growth and bones fusing together.

Like ankylosing spondylitis, spinal stenosis also affects the spine. However, spinal stenosis affects the spinal canal. The spinal canal is the tunnel that runs through each vertebra. Inside this tunnel is the spinal cord, which is a large nerve that carries messages from your brain to the rest of your body. In spinal stenosis, the spinal canal becomes narrow, putting pressure on the spinal cord.

Learning the differences between ankylosing spondylitis and spinal stenosis can help you better understand the root of your back problems. Here are six key differences between the two conditions.

1. Causes: Ankylosing Spondylitis Is an Autoimmune Disease

In ankylosing spondylitis, the immune system attacks the body by mistake. Autoimmune diseases like AS can be linked to certain genetic changes. Scientists have found over 60 different genetic mutations (or changes) that may be connected to AS. For example, many people with AS have a mutation in the HLA-B27 gene. As a result, AS runs in families. You’re more likely to get it if your parents or other close relatives also have it.

Many factors can cause spinal stenosis. Nine percent of cases begin at birth, either from inherited genes or developmental problems that affect bone growth (like dwarfism).

However, most people who get spinal stenosis develop it after age 50. Spinal stenosis may happen as a normal result of aging or from wear and tear on the body over time. It can be caused by bone overgrowth in degenerative diseases like osteoarthritis or by herniated disks, thickened ligaments, vertebral fractures, or growths inside the spinal cord such as cysts or tumors. Any of these may lead to changes that can narrow the spinal canal.

2. Symptoms: Ankylosing Spondylitis Has a Wider Range of Symptoms

Ankylosing spondylitis can affect people differently. Symptoms may include pain and stiffness in the neck and back. This pain is worse in the morning and gets better with movement.

In addition, AS can cause:

• Pain and inflammation in peripheral joints or hips
• Diarrhea
• Rashes
• Stomach pain
• Vision problems

People with AS often have chronic fatigue, meaning they feel tired all the time, even after resting. They may also have a poor appetite and lose weight unexpectedly.

Depending on where the narrowing happens, spinal stenosis symptoms tend to affect the back and the limbs. The spinal canal runs from your neck down to your lower back. Symptoms can include numbness, tingling, or weakness in the arms, hands, feet, or legs. You may feel clumsy and struggle with actions like buttoning buttons or maintaining your balance. Spinal stenosis can also be painful, causing dull aches or shooting pain. Unlike AS, spinal stenosis pain is worse with movement and may improve with rest.

3. Diagnosis: Diagnosing Ankylosing Spondylitis Is Less Straightforward

Ankylosing spondylitis can be tricky to diagnose because there’s no single test for it. Instead, doctors may use blood tests to check the level of inflammation. They may also order MRI scans, X-rays, and genetic testing to come up with the right diagnosis. They’ll also do a physical exam and ask about your symptoms and medical history.

An AS diagnosis means that there’s an issue with the immune system that’s affecting the whole body. It’s not just a problem with the spine. A doctor who specializes in autoimmune disorders, known as a rheumatologist, will need to review your case and bloodwork to decide if you have AS.

Figuring out if someone has spinal stenosis may be more obvious with a few simple tests. Your healthcare provider will still start with a physical exam, having you bend in different positions or pressing on areas of your back to find out where the pain is coming from. They’ll also use imaging tests, like X-rays and MRI scans, to look at your spine. In addition, your healthcare provider may order a CT scan or CT myelogram. These tests use X-rays and dyes to get a clearer picture of your spinal cord.

4. Progression: Ankylosing Spondylitis May Have a Bigger Effect on Daily Life

People with AS have chronic inflammation throughout their bodies. This impacts different organs and can lead to issues like joint problems that may require surgery and a risk of impaired vision. Significant fatigue and brain fog can affect quality of life with AS, making it difficult to maintain a job or an active lifestyle. Similar to symptoms of other autoimmune diseases, AS symptoms may come and go. Although it’s a long-term condition that won’t completely go away, some people with AS can have long periods with no symptoms, under the correct treatment. This is known as disease remission.

Most people with spinal stenosis can manage the condition without the need for surgery. Serious complications are not likely. However, a severe case of spinal stenosis can lead to problems with sexual function and bladder or bowel control. Very rarely, spinal stenosis can cause the legs to become paralyzed.

5. Risk Factors: Spinal Stenosis Usually Happens Later in Life

Ankylosing spondylitis is more likely to impact people who also have other autoimmune conditions, like inflammatory bowel disease or psoriasis. According to Cleveland Clinic, it’s also more common in males. Over 80 percent of people with AS are diagnosed around age 30.

Spinal stenosis is much more common than AS. Except for cases where a baby is born with spinal stenosis, the condition generally impacts adults over 50.

Spinal fractures and osteoarthritis are common complications of ankylosing spondylitis due to spinal stiffness. These are also risk factors for developing spinal stenosis. If you’ve developed spinal stenosis along with your ankylosing spondylitis, know that you’re not alone. Some MySpondylitisTeam members have shared their experiences with spinal stenosis.

“My AS has gotten so bad that it is causing spinal stenosis,” one member wrote. Another said, “Spinal stenosis is what is causing most of the pain in my back.”

6. Treatment: Some Treatment Options Differ

Pain management and physical therapy are common aspects of managing both ankylosing spondylitis and spinal stenosis. Staying active can help people with AS or spinal stenosis feel better when done safely. But unlike treatment for spinal stenosis, AS treatment also focuses on decreasing the body’s inflammation levels.

People with AS may be prescribed biologic disease-modifying antirheumatic drugs (DMARDs). These medications work by reducing inflammation. As a result, they may help prevent complications or the progression of AS. People with AS may also use nonsteroidal anti-inflammatory drugs (NSAIDs) and, more rarely, corticosteroids to lower inflammation and pain.

NSAIDs and corticosteroids can also be part of the treatment plan for spinal stenosis, but for long-term treatment, doctors may recommend other medications. For instance, doctors may prescribe the anti-seizure medication gabapentin, muscle relaxants for cramping, and antidepressants like amitriptyline to manage spinal stenosis symptoms.

Surgery is considered a last resort treatment for both AS and spinal stenosis. Most people with either condition don’t need to have surgery. However, it’s used if symptoms are severe and other treatments aren’t helping.

People with AS may have surgery to replace their hips or to straighten the spinal column. Some surgical procedures increase space by removing vertebrae or tissue or adding spacers between the vertebrae. These are considered decompression surgeries because they relieve pressure.

One study showed that decompression surgery significantly improved symptoms of spinal stenosis in over 70 percent of people with lumbar spinal stenosis. In severe cases, people may have spinal fusion surgery to connect two vertebrae together for better stability.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 99,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Have you been diagnosed with ankylosing spondylitis or spinal stenosis or both conditions? How do you manage your symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.