Surgery for Ankylosing Spondylitis

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

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.

Type of Spine Surgery
The type of spine surgery your surgeon recommends is based on many factors including your symptoms, the severity of the spinal deformity (eg, chin-on-chest),  rigidity of the spine, your age, lifestyle (eg, use tobacco), and overall health. Sometimes the surgery involves one or more procedures. Three of the procedures to treat ankylosing spondylitis are explained below.

  • 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
Immediately following surgery, you are moved from the operating room into the recovery area. There nurses and other medical professionals monitor your vital signs, including postoperative pain. Some types of spinal surgical procedures require you to wear a brace, which is explained to you before surgery.

Depending on the type of surgery, you may spend one or more nights in the hospital. During hospitalization, nurses keep a close watch on you and you will be up sitting in a chair and walking soon. Again, depending on the type of surgery, some patients are up and walking with assistance the same day of surgery.

Updated on: 03/13/17
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Surgery Recovery: From Hospital to Home
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Surgery Recovery: From Hospital to Home

The first part of recovery from spine surgery begins in the hospital.
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