In rare cases of advanced ankylosing spondylitis or acute injury, spine or hip surgery is recommended to restore function and mobility to improve quality of life.
Surgery is necessary for acute spinal fractures and ankylosing spondylitis-induced deformity.
Surgery is beneficial when ankylosing spondylitis causes difficulties with daily activities, such as driving or working, or more serious complications from spinal deformities, such as difficulty breathing or swallowing.
In This Article:
Indications for Ankylosing Spondylitis Surgery
Surgery is typically recommended when optimal non-surgical therapies do not adequately treat severe and progressing ankylosing spondylitis and when deformities significantly impact the quality of life.
Specific indications for surgery include,:
- Atlantoaxial instability, characterized by excessive movement and instability between the first two cervical vertebrae, with neurologic impairment
- Cervical flexion deformities (hyperkyphosis) with impaired ability to look in a forward direction
- Severe hip involvement, with persistent pain or limitation in mobility
- Severe functional disability, with difficulty completing everyday tasks, such as eating and drinking
Surgical intervention is also recommended for some acute spinal fractures, which commonly occur in the cervical spine.,,
Types of Surgeries for Ankylosing Spondylitis
Lumbar laminectomy relieves neural compression by removing the bone compressing the nerve tissue.
There are several approaches aimed at addressing severe joint damage and spinal deformities in ankylosing spondylitis. Standard surgical procedures are discussed below.
- Spinal osteotomy involves reshaping or realigning the vertebrae to correct deformities, but this procedure does not fully restore the mobility and flexibility of the spine.
Spinal fusionis performed to stabilize the spinal segment by fusing two or more vertebrae and immobilizing the spinal motion segment(s).
Read more about Spinal Fusion Surgery on Spine-health.com
- Spinal decompression surgery involves removing a piece of bone that places pressure on the spinal cord or spinal nerve roots. The most common type of decompression surgery is a laminectomy.
Total hip arthroplasty involves the replacement of a severely damaged hip joint with an implant in advanced ankylosing spondylitis with hip involvement.,
Read more about Total Hip Arthroplasty
Most spinal surgeries involve correcting deformities and hunched posture (kyphosis).
When Ankylosing Spondylitis Surgery May Not be Performed
Surgical procedures are not indicated when symptoms of ankylosing spondylitis are mild to moderate and well-controlled with medications and physical therapy.
Additionally, surgery is not always the preferred course of action for acute fractures or dislocations, and some experts believe that these injuries should be managed by immobilization only, such as with a brace.
Individuals with certain underlying medical conditions (eg, severe malnutrition or severe hyperkyphosis, which interferes with intubation) are at a significantly increased risk for surgical complications, and the potential benefits of surgery do not always outweigh the risks in these cases.
Ankylosing Spondylitis Surgery: Potential Risks and Side Effects
The complications of ankylosing spondylitis surgery vary depending on the type of procedure. Potential risks and side effects include,,:
- Bleeding
- Post-surgical infection
- Thromboembolism (blood clot)
- Nerve damage
- Aortic rupture
- Dysphagia (difficulty swallowing)
Permanent or life-threatening complications of corrective spinal surgeries are rare.
Factors such as age and underlying conditions (eg, obesity, osteoporosis, or cardiac disease) impact the overall risks of surgical procedures and recovery.,
Ankylosing Spondylitis Surgery: Success Rate and Long-Term Outcomes
The factors affecting the success rate and long-term outcomes of ankylosing spondylitis spinal surgery are related to the area of the spine where the surgery is performed and the experience and skill of the surgeon.
Surgical corrections of the thoracolumbar spine appear to be associated with a greater risk of post-surgical complications.
Hip surgery outcomes in ankylosing spondylitis
Most individuals who elect to have a total hip replacement experience long-term pain relief and improved mobility for at least 10-15 years post-surgery.
It is essential to discuss the risks, benefits, and surgical alternatives with the surgeon before considering surgery for ankylosing spondylitis.
