Surgery for Ankylosing Spondylitis
Most patients with ankylosing spondylitis do not require surgery. However, there are situations where surgery is a consideration:
- The spinal deformity is in a fixed flexed position. The magnitude (angle) of the deformity is the most important consideration. An example is forward flexion so great the chin rests near or on the chest (commonly called chin-on-chest deformity). 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 even have difficulty eating.
- The stability of the spine is compromised. An unstable spine means that it moves too much and the joints aren't controlling the spine mobility as they should. Spinal instability puts the patients more at risk for nerve damage.
- Neurologic deficit exists. Neurologic deficit involves problems with the nerves, such as weakness or numbness.
- A combination of any of the above.
Several surgical procedures are available to the spinal surgeon. The surgeon will recommend the best procedure for you, based on various factors (age, location of the deformity, severity of the deformity, etc.). Some spinal procedures used to treat ankylosing spondylitis are:
- Osteotomy: 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.
- Decompression: Other procedures, such as laminectomies, decompress the spinal canal and associated nerves, restoring or preventing neurologic dysfunction. "Decompress" means to take pressure off the spinal cord or nerves.
- Spinal Instrumentation and Fusion: These 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.
Recovery from Surgery for Ankylosing Spondylitis
Post-operative patients will be given medication to control pain.
At the appropriate time during recovery (a time determined by the doctor monitoring your recovery process), you will begin a program of physical therapy (PT) to strengthen the spinal muscles and increase flexibility. The physical therapist will teach you how to incorporate principles of good posture into their everyday life.
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 TLSO (thoracolumbar sacral orthotic) is a jacket-like brace worn to stabilize the thoracic-lumbar-sacral spinal regions as the spine heals from surgery. This brace may need to be worn for six months (or until healing occurs) following surgery.
If the patient was prescribed a brace to wear, their progress will be monitored during follow up visits with their physician.