Most people with ankylosing spondylitis (AS) manage well on medications and physiotherapy. The surgical intervention is only done in the case of severe symptoms and complications due to long-standing AS.
Studies and research show that surgery can have successful outcomes in people with AS who are in severe pain, experience severely limited mobility or have significantly reduced quality of life. The rate of success for AS may vary depending on the severity of the condition and the person’s overall health. Surgery can be an option in the form of joint replacements, particularly in the knees and hips. Surgical correction is also possible for those with severe downward curvature (severe flexion deformities) of the spine, particularly in the neck, although this procedure is considered risky. The surgeon will discuss the best options for the patient based upon their physical exam and imaging studies. Several types of surgery are available to treat AS, including
Laminectomy and discectomy:
- It is a surgery to remove the lamina, a bone at the back of each vertebra, from the affected area of the spine.
- This helps relieve pressure on the spinal cord and receives the pressure along the nerve(s) running along the spinal cord.
- The partial and/or complete removal of portions of the spinal columns, specifically, discs and vertebrae, depends on the patient’s condition and symptoms. In a few cases, the procedure also involves disc replacement with artificial discs or metal rods.
- It is a type of surgery used to join two or more vertebrae through the use of supplementary bone tissue and spinal instrumentation.
- Spinal fusion removes the damaged tissue and locks two or more vertebrae in place.
- This prevents unwanted movement that can lead to irritation and inflammation of the spinal nerves, thus stabilizing the spine.
Hip joint replacement:
- In this procedure, portions of the hip bone or joint are taken out and replaced with prostheses.
- A doctor may recommend hip replacement when AS causes mobility limitations in the joints.
- In most cases, the hip joint replacement may be a minimally invasive procedure.
- In extremely rare cases, a procedure called an osteotomy with fusion may be used to fuse curved vertebrae together and straighten the spine.
- The goal of this surgery is to eliminate compression of the nerve roots and to stabilize and fuse the spine with grafts, screws and rods.
- Many patients present with fixed deformities of the spine and these patients can be helped with corrective osteotomies of the spine. It is possible to improve the quality of life in these patients.
- For extreme cases of kyphosis (bending of the spine or hunchback posture), particularly in the cervical or neck area in which breathing and other normal functions are severely impaired, spinal surgery may be recommended to straighten the back and restore some measure of overall back support.
- This procedure cuts, shaves and realigns bones that have become deformed as a result of the AS, such as the vertebrae, ribs and shoulders.
Research shows that a direct correlation was found between improved quality of life and surgical intervention.
Currently, the research hotspot of surgical treatment focuses on the choice of surgical path, preoperative management, prevention and treatment of the complications. With scientific and technological development, early diagnosis and effective treatment of AS will be possible. The socioeconomic burden of AS will be significantly reduced and patients' suffering will be alleviated.
What are the warning signs and symptoms of ankylosing spondylitis?
Ankylosing spondylitis (AS) is a type of arthritis that primarily affects the spine and causes inflammatory back pain. The condition also affects the joints in the shoulders, hips, ribs, heels and other joints. The warning signs you may have for AS include
- Persistent and excruciating pain in the lower back, heel(s), joints or chest, especially after waking up in the morning, for more than 90 days.
- Pain may come and go, but it’s gradually moving up your spine. And it’s getting worse.
- Patients may get relief from their symptoms only by taking nonsteroidal anti-inflammatory drugs (NSAIDs)/painkillers.
- Early signs and symptoms of AS include pain and stiffness, particularly in the sacroiliac joint (lower back and hips), especially during early mornings or after long periods of inactivity. The stiffness, inflammation and pain can be seen in other joints of the body. The shoulders, neck, hips, ribs, heels and small joints of hands and feet may be involved.
- Systemic features such as weight loss, fever, fatigue and inflammation are common.
- Enthesitis: Inflammation of ligaments, tendons and capsules attached to the bone, mainly in the spine, sometimes in the Achilles tendon (back of the heel) and also in the cartilage between the breastbone and ribs is a common symptom.
What is the outlook of patients with AS?
The course of the disease is hard to predict. The signs and symptoms of ankylosing spondylitis (AS) may get milder over the next few years or worse. Most people are able to function well unless there is a lot of damage to the hips or the spine. A specific life expectancy for people with AS has not been established. However, proper diagnosis and treatment for AS are important not only to slow or stop the joint progression and possible disability, but also to reduce the widespread inflammation in the body that can lead to complications such as heart disease.
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Zeitschrift för Rheumatologie: "Surgical Management of Ankylosing Spondylitis." https://pubmed.ncbi.nlm.nih.gov/29101454/