Non-surgical Treatments for Ankylosing Spondylitis

Treatment for ankylosing spondylitis (AS) is aimed at relieving the patient's symptoms and preventing spinal deformity. Seldom is surgery required, and there are several non-surgical treatment options available.

Standard non-surgical treatments include:

• Exercise: This is one of the best ways to gain long-term pain relief, especially when you exercise and take medications for inflammation (see NSAIDs below). When you exercise, it helps maintain your range of motion, which keeps your joints mobile. Also, a lack of activity—not exercising at all for a lengthy period—may allow your spine to fuse more because the joints aren't being used as much. Exercise can also help you maintain good posture because you strengthen your muscles to better support the spine.
• Non-steroidal anti-inflammatory drugs (NSAIDs): The earlier AS is diagnosed, the better it responds to medications such as NSAIDs. By reducing inflammation, these medications can help reduce pain, stiffness, and general discomfort. Some prescription strength NSAIDs used for AS are: Indomethacin, Naproxen, Phenylbutazone, Sulfasalazine, and Fenprofen.
  
  However, most NSAIDs do have gastrointestinal side effects (bleeding, ulcers, etc.). Cox-2 inhibitors, a type of NSAID, do not produce these side effects.
• Physical therapy (PT): Physical therapy teaches the patient exercises designed to strengthen back muscles, improve posture, and increase flexibility and range of motion. A physical therapist can also teach you techniques to enhance breathing, since reduced lung function is a possible side effect of ankylosing spondylitis.
• Self-care techniques: Activities that help to alleviate stiffness include taking a warm bath or shower, gentle stretching movements performed in bed prior to rising, or aquatics such as swimming.

If you have a spinal fracture—very possible in ankylosing spondylitis as your spine fuses—there are several non-surgical treatments available:

• Bracing: A TLSO (thoracolumbar sacral orthotic) is a jacket-like, sleeveless brace that stabilizes the thoracic-lumbar-sacral spinal regions. It may be worn for 3 months or more, depending on the patient's disorder and the severity of the spinal fracture and deformity.
• Halo Brace: This treatment is used for cervical fractures, and it's considered a form of spinal traction. The apparatus immobilizes the cervical spine by placement of pins into the skull secured to a metal ring—a halo—around the head. Two metal rods then attach the ring to a well-fitted jacket. The halo brace may be worn for 3 months or more depending on the patient's disorder and the severity of the spinal fracture and deformity.