The majority of patients suffering from ankylosing spondylitis do not need to have surgery; however, surgery may be an option for patients suffering from severe ankylosing spondylitis and spinal deformities related to it, especially in the spine or hip joints. There are two types of surgery that may be an option for severe cases, depending on the patient’s clinical situation and symptoms: joint replacement or osteotomy.

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Joint Replacement

Ankylosing Spondylitis
Ankylosing Spondylitis. Enlarge

For the hip, shoulder and knee problems related to this form of arthritis, joint replacement surgery can allow people to regain the use of joints that have been affected by ankylosing spondylitis. Hip, shoulder and knee replacement are becoming increasingly successful for people with severe pain and limited mobility in those joints.

Osteotomy

Surgical correction of the spine itself is also possible to address pronounced deformities such as a humpback or swayback, or the chin-on-chest posture characteristic of patients with advanced ankylosing spondylitis. Indications that a patient may benefit from this type of surgery include:

  • Severe, unremitting pain that is not sufficiently relieved by non-surgical care
  • Neurological deficits
  • Spinal instability
  • Decreased ability to hold the head up and see horizontally
  • Difficulty in completing everyday activities due to spinal deformity.

For patients who have not benefited from other forms of treatment, surgery can provide relief from some of the physical and associated emotional difficulties of spinal deformity caused by advanced ankylosing spondylitis. The decision to have surgery can be a difficult one, requiring patients to weigh the risks and benefits carefully.

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Written by Judith Frank, MD
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