Treatment for ankylosing spondylitis often includes a combination of nonsteroidal inflammatory drugs (NSAIDs), biologic medications, and physical therapy. As medications for ankylosing spondylitis improve, surgeries are becoming less common, says Ali Ajam, MD, a rheumatologist at The Ohio State University Wexner Medical Center in Columbus. Surgery is typically performed in the case of a fracture or severe joint damage that impacts your mobility or ability to perform everyday tasks.
Signs That You May Need Surgery
There are some warning signs that you may need surgery to help treat your ankylosing spondylitis. If you have any of the following signs or symptoms, make sure to discuss them with your doctor.
Severe pain that can’t be controlled with your regular medications, including pain medicationsSpinal fractureInability to lift your head and look forward due to spinal fusionNot being able to drive because you can’t position your body correctlyNumbness and tingling in your arms or legs caused by pressure on the spinal cord and nervesLimited motion in your hip area and pain when you have to bear any weight on your hip
Types of Surgery for Ankylosing Spondylitis
When people with ankylosing spondylitis do need surgery, it’s most often a total hip replacement or a procedure called osteotomy of the spine, according to Susan Goodman, MD, a rheumatologist at Hospital for Special Surgery in New York City. “Ankylosing spondylitis classically affects the spine,” Dr. Goodman says. “In severe cases, the hips and shoulders and, less frequently, the knees can also be damaged by arthritis.” If these joints become severely damaged, you may require joint replacement surgery. Hip replacement is the most common joint replacement surgery performed for ankylosing spondylitis. According to a review published in January 2019 in The Journal of Rheumatology, up to 40 percent of people with ankylosing spondylitis experience hip involvement, and 12 to 25 percent of those with the condition will eventually require total hip replacement. In a total hip replacement, also called arthroplasty, the diseased parts of the hip joints are removed and the ends of the thigh bone and hip socket are replaced with artificial parts, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Although it’s common for ankylosing spondylitis to affect both hips, it’s not usually severe enough to require surgery, Goodman says. If ankylosing spondylitis started when you were young and severely affected your spine, it’s more likely that you will have hip damage, she says. If you have ankylosing spondylitis that started when you were a child, you may be more likely to need a hip replacement than people whose condition set in when they were adults, according to research published in May 2015 in the journal Arthritis Care & Research. Those with childhood- and adult-onset ankylosing spondylitis appear to be about equally likely to need a procedure called hip resurfacing or hip arthroplasty revision or re-revision, the study suggested. People whose knees, shoulders, or joints of the hands or feet are affected by ankylosing spondylitis may require replacement surgery for these joints. As in hip replacement surgery, surgery for these joints involves removing damaged parts and replacing them with man-made parts to help relieve pain and improve function, according to the NIAMS. There are several types of spinal surgery that may be performed in people who have ankylosing spondylitis. If your spine has fused into a curved position, you may require an osteotomy of the spine. The procedure helps restore the alignment and balance of the spine. It’s a complex surgery that usually involves opening and straightening vertebrae in the spine and is used to help correct forward flexion, or kyphosis, of the spine. If not treated, this kind of spinal deformity can turn into severe ankylosing spondylitis, Goodman says. After osteotomy, spinal fusion surgery may be performed to help stabilize the spine in areas where bone has been damaged or removed. The surgeon will insert instruments such as metal rods or screws to fuse bones together and help keep your spine straight. A procedure called a laminectomy may be used to relieve pressure on the spinal cord and nerves. Also known as decompression surgery, a laminectomy involves removing the lamina — the part of the vertebrae that covers the spinal canal — to create more space for the spinal cord. There aren’t concrete, recent statistics that show how many people with ankylosing spondylitis end up having these procedures, but doctors say the need for surgery, especially an osteotomy, is infrequent.
Benefits of Having Surgery
If you do need surgery for your ankylosing spondylitis, your quality of life should improve afterward. “You’ll be able to do more, such as lifting your head and looking forward and driving,” Dr. Ajam says. “There’s also pain relief.” But there may be a limit to how much an osteotomy can restore normal posture, Goodman says. If you have a total hip replacement, surgery can help reduce pain and make it easier to move around again. Although nothing has been proved to prevent the need for surgery for ankylosing spondylitis, there are steps you can take to help manage the condition and reduce your risk of joint damage. Ajam offers this advice: “There are things everyone should do, regardless of having ankylosing spondylitis, such as focusing on good nutrition and regular exercise,” he says. To improve the health of your muscles and ligaments, he suggests yoga, stretching, and strengthening exercises. You should also follow your treatment plan as prescribed by your doctor.
