Ankylosing Spondylitis: Treatment and Recovery

4 potential indications that spine surgery is necessary to treat ankylosing spondylitis

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Ankylosing spondylitis (AS) is a type of inflammatory arthritis that can affect the spine, such as the sacroiliac (SI) joints and facet joints. In severe cases of AS, new bone formation can cause the spine to abnormally fuse (join or grow together). Fortunately, most patients with ankylosing spondylitis do not require surgery. However, there are four basic indications when surgery may be considered or recommended.

#1. 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.

chin-on-chest deformity, front view, x-ray

#2. 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.

#3. Neurologic deficit exists. "Neurologic deficit" means a nerve problem that causes sensory (eg, pain, tingling sensations) and/or motor changes (eg, weakness).

#4. A combination of any of the above.

Managing Ankylosing Spondylitis Complications
AS may cause complications that necessitate additional treatment. An example is if you develop a spinal fracture; anklylosing spondylitis increases your risk of suffering a broken bone in your spine.

If you experience a spinal fracture, the treatment will largely be based on the severity, location, and type of spinal fracture you have. For example, vertebral compression fractures (VCF) may be treated with minimally invasive vertebral augmentation procedures, such as kyphoplasty or vertebroplasty. On the other hand, spinal fractures of a more traumatic nature (such as a burst fracture) may require surgical decompression and spinal fusion surgery to treat the fracture and stabilize the spine.

Spine Surgery for Ankylosing Spondylitis
The recommended surgery may involve more than one procedure and is selected based on your specific symptoms and condition, and your overall health. Below are the types of spine surgery performed for AS:

  • Decompression procedures are performed to take pressure off the spinal cord and/or nerves. Decompressive procedures (eg, laminectomy) help relieve pain by removing tissues that compress a neural structure, such as a bone spur (osteophyte) or damaged intervertebral disc.
  • Osteotomy involves cutting and/or removal of part of a spinal bone to treat angular deformities.
  • Spinal instrumentation may involve implantation of interbody devices, rods, plates and or screws to provide immediate spinal stabiliation. Instrumentation is combined with spinal fusion that involves adding bone graft into and around the instrumenation to stimulate bone growth that joins two or more bones together into a solid mass.

Depending on the extent and type of spine surgery performed, you may need to wear a brace to support your spine while it heals.

Recovering from Ankylosing Spondylitis Surgery
Following your surgeon’s postoperative instructions is key to a successful recovery from spine surgery, so make sure to ask questions if you are unclear about how you should take care of yourself after your procedure.

Although AS is not curable, few people are debilitated by the disease. Occasional pain and stiffness will likely not prevent you from leading a healthy and productive life. You have a lot of power when it comes to managing your AS symptoms once your surgery recovery is complete, so engage in the different treatments available to you. You can treat pain and inflammation with medication; alleviate stiffness with exercise, ice, and a heating pad; and increase flexibility, endurance, and range of motion with gentle stretching.

Commentary by 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.

Updated on: 03/15/17
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Second Opinion on Spine Surgery: Rude or Smart?
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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