Ankylosing Spondylitis: Treatment and Recovery

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Treatment for ankylosing spondylitis (AS) is aimed at relieving the patient's symptoms and preventing spinal deformity. Seldom is surgery required.

Blue pill blistersStandard treatment includes non-steroidal anti-inflammatory agents and physical therapy (PT). PT teaches the patient exercises designed to strengthen back muscles, improve posture, increase flexibility and range of motion, and techniques to enhance breathing. 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.

Spinal fractures resulting from AS may be treated non-surgically using traction and/or bracing. Treatment for cervical fractures may necessitate a halo brace. This apparatus immobilizes the cervical spine by placement of pins into the skull secured to a metal ring (halo). The halo is combined with a well-fitted jacket. A TLSO (thoraco lumbar sacral orthotic) is a jacket-like brace (sleeveless) that stabilizes the thoracic-lumbar-sacral spinal regions. These braces may be worn for 3 months or more depending on the patient's disorder.

Most patients with ankylosing spondylitis do not require surgery. Surgery is a consideration when:

(1) The spinal deformity is in a fixed flexed position. The magnitude (angle) of the deformity is paramount. An example is forward flexion so great the chin rests near or on the chest. The functional limitations of this particular deformity are great. In the example, the patient would be unable to look forward, make visual contact, drive, and may have difficulty eating.

(2) The stability of the spine is compromised.

(3) Neurologic deficit exists.

(4) A combination of any of the above.

Several surgical procedures may be available to the spinal physician. The type of procedure is dependent on the disorder, spinal stability, neurologic compromise, and other variables.

  • During an osteotomy bone is cut to correct angular deformities. The bone ends are realigned and allowed to heal. Spinal instrumentation and fusion may be combined with an osteotomy to stabilize the spine during healing.
  • Other procedures decompress the spinal canal and associated neural elements restoring or preventing neurologic dysfunction.
  • Spinal Instrumentation and Fusion are surgical procedures used to correct spinal deformity and to provide permanent stability to the spinal column. These procedures join and solidify the level where a spinal element has been damaged or removed. Instrumentation uses medically designed hardware such as rods, bars, wires, and screws. These devices hold the spine straight during fusion. Fusion is the adhesive process joining bony spinal elements.

Following certain cervical procedures, the patient may need to wear a halo brace to immobilize the cervical spine. The halo, a metal ring, is secured to the skull with pins and combined with a well-fitted jacket. A thoraco lumbar sacral orthosis (TLSO) is a jacket-like brace worn to stabilize the thoracic-lumbar-sacral spinal regions. This brace may need to be worn for six months (or until healing occurs) following surgery.

Although ankylosing spondylitis (AS) is not curable, most people are only mildly affected. The condition tends to become less severe with age (eg, progression). Episodic pain and stiffness will not prevent most patients from leading a productive life. Pain can be treated using medication, stiffness alleviated with exercise and modalities (eg, heating pad), and a program of stretching can increase flexibility and range of motion.

Post-surgical patients will be given medication to control pain. At the appropriate time during recovery, the patient will begin a program of physical therapy (PT) to strengthen the spinal muscles and increase flexibility. The physical therapist will teach the patient how to incorporate principles of good posture into their everyday life.

If the patient was prescribed a brace to wear, their progress will be monitored during follow up visits with their physician.

Updated on: 03/04/16
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Ankylosing Spondylitis: Description and Diagnosis
Baron S. Lonner, MD
Dr. Shaffrey has presented an overview of problems manifested in the patient with ankylosing spondylitis. He has pointed out that the majority of patients do not require surgery for related spinal disorders.

A number of points warrant further emphasis. First of all, these patients are prone to fracture of the rigid spinal column even with relatively trivial trauma such as a fall or a low-speed motor vehicle accident. This can result in severe instability, spinal deformity, and most importantly, deteriorating neurological function or paralysis. If an individual with AS has pain following a trauma, further investigation with x-rays and possibly CT scan and/or MRI is warranted.

The problem of spinal malalignment, such as chin-on-chest deformity, has been discussed by Dr. Shaffrey. Once a deformity has been established, it is quite rigid or stiff and typically is not correctible. Before this occurs, exercise and stretching and even bracing may be considered to minimize these deformities which can be debilitating. The patient tends to be pitched forward and often has difficulty looking straight ahead as the head is often fixed in a downward position. If this occurs, osteotomies or cutting through the spinal column may be required to restore a more horizontal gaze and comfortable alignment.

Consultation with a spinal specialist early in the disease process may be warranted.

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Ankylosing Spondylitis: Description and Diagnosis

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