Treatment Treatment for
ankylosing spondylitis (AS) is aimed at relieving the
patient's symptoms and preventing spinal deformity. Seldom is surgery required.
Standard treatment includes nonsteroidal 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.
Surgery
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 TLSO (thoraco lumbar sacral orthosis)
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.
Recovery
Although ankylosing spondylitis (AS) is not curable,
most people are only mildly affected. The condition tends to become less severe
with age (e.g. 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 (e.g. 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.
