The majority of people who have ankylosing spondylitis never have surgery; however, surgery may be an option for patients who have spinal deformities or severe joint problems. What surgery is recommended depends on the patient’s clinical situation and symptoms.
A patient may benefit from spine surgery if he or she has:
- Severe, unremitting back or neck pain that has not responded to nonsurgical treatment
- Nerve damage caused by spinal deformity
- An unstable spine, meaning that a bone(s) has fractured
- Decreased ability to hold the head up and see horizontally
- Difficulty completing everyday activities like eating and drinking because of spinal deformity.
There are three types of spine surgery that may be used to treat ankylosing spondylitis. Only a surgeon can decide which surgery, if any, is appropriate.
- Osteotomy of the spine. When surgeons cut bones to shorten, lengthen, or change their alignment it is called osteotomy [oss-tee-aut-oh-mee]. For people with ankylosing spondylitis, osteotomy of one or more of the spine’s bones can help improve posture and correct deformities. However, osteotomy cannot fully restore the spine’s mobility and flexibility.
- Spinal fusion instrumentation. The goal of spinal fusion instrumentation is to stabilize the spinal column. It may be done if bones have been damaged or if significant bone has been removed during osteotomy. The surgeon will fuse two or more bones together using specially designed hardware, such as wires, screws, rods, and cages. After surgery, the fused joints will not have any movement—the tradeoff for spine stability is spine flexibility.
- Spinal decompression. Ankylosing spondylitis can put pressure on the spinal cord or nerves, which causes numbness, weakness, loss of coordination, or tingling in the arms or legs. Surgeries that take pressure off the spinal cord and nerves are called decompression surgeries. These surgeries typically involve removing a small amount of vertebral bone (a type of osteotomy). The most common type of decompression surgery is a called a laminectomy.
These surgeries are typically elective surgeries, meaning a patient will decide whether or not to have a procedure.
People who have hip, shoulder, and knee problems related to ankylosing spondylitis may consider joint replacement surgery. Joint replacement surgery involves replacing the cartilage and bone surfaces of a joint with man-made materials—typically metal or plastic.
Read more about surgery to treat arthritis pain in the Surgery Health Center
Hip, shoulder, and knee replacements are becoming an increasingly common choice for people with severe pain and limited mobility in those joints. As with any major surgery, joint replacement surgeries carry risks.