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Spinal Surgery for Ankylosing Spondylitis: What To Know

Posted on June 30, 2021
Medically reviewed by
Diane M. Horowitz, M.D.
Article written by
Kristopher Bunting, M.D.

Ankylosing spondylitis (AS) is an advanced form of spondyloarthritis where bones in the spine have fused (ankylosed) from abnormal bone growth. When AS causes significant pain or loss of function that cannot be treated by other means, surgery may be required to alleviate symptoms.

What Is Ankylosing Spondylitis?

Ankylosing spondylitis, also called radiographic axial spondyloarthritis, is a type of spondyloarthropathy. This group of related autoimmune diseases causes pain and inflammation in the joints (especially the spine) — and sometimes in the eyes, lungs, and heart.

Symptoms

AS can involve the neck (cervical spine), upper back (thoracic spine), lower back (lumbar spine), sacrum (sacral spine), sacroiliac joint (where the spine joins the pelvis or hip bones), and hip joints. Symptoms of AS that are directly related to the spine include:

  • Back pain
  • Neuropathy (pain, numbness, or tingling in the extremities)
  • Spinal deformity
  • Loss of range of motion
  • Spinal instability

Treatments

Treatments for AS can target pain and other symptoms, decrease inflammation, and improve strength and mobility. Some of the most important treatments for AS include:

  • Exercise
  • Physical therapy
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Biologic drugs
  • Conventional disease-modifying antirheumatic drugs
  • Drugs to treat specific symptoms, including muscle relaxants, antidepressants, and opioids for acute pain
  • Surgery

When Is Spinal Surgery Appropriate for Ankylosing Spondylitis?

Before you and your health care team consider surgery for your AS, you should typically try other treatments, such as exercise, physical therapy, and medication. When ankylosing spondylitis has progressed to the point that other treatments do not relieve severe symptoms, spinal surgery may be required to attempt to alleviate them. Advanced symptoms of AS that may require surgery include kyphosis, neuropathy, and spinal instability.

Kyphosis

Extreme kyphosis is a forward curvature of the upper spine, sometimes called hyperkyphosis. This symptom can leave the upper back and neck in a permanently fixed flexed position (leaning forward), causing a hunchback and loss of normal function.

Neuropathy

Pinched nerves, or pressure on the nerves leaving the spinal column, can cause nerve damage. This can result in muscle weakness or pain, numbness, and tingling of the extremities (called neuropathy) that may not respond to other treatments.

Spinal Instability

Spinal instability refers to when portions of the spine are hypermobile (move too much). Spinal instability makes it difficult to bear weight and maintain normal balance. Spinal instability also increases your risk of nerve damage.

Types of Spinal Surgery for Ankylosing Spondylitis

Spinal surgeries to treat AS include osteotomy, decompression, and spinal fusion. The type of surgery used depends on what specific problems are causing symptoms.

Osteotomy

Spinal osteotomy involves removing portions of bone in the spine to separate fused vertebrae and straighten abnormal curvature.

Decompression

Spinal decompression (laminectomy) entails removing a portion of the vertebra called the lamina. This relieves pressure on the spinal nerves caused by AS. The lamina encloses the spinal column, the hollow space in the spine that the spinal cord runs through. Decompression is used to treat other conditions that result in pressure on the spinal nerves, such as a herniated intervertebral disk.

Spinal Instrumentation and Spinal Fusion

Spinal instrumentation fixes two or more vertebrae in place with metal hardware, such as screws, wires, rods, and plates. Spinal fusion can be performed with hardware alone or may include a bone graft to help adjacent vertebrae fuse together. Spinal instrumentation and fusion can be used to treat spinal instability or to hold vertebrae in place after osteotomy or laminectomy. This stabilizes the spine and keeps it in a healthy position.

Risks and Benefits of Surgery

Surgery may be beneficial in treating AS, but it is not without risks. Understanding the potential risks and benefits of spinal surgery for ankylosing spondylitis will help you and your health care provider decide whether or not surgery is the best choice for you.

Some of the potential benefits of surgery include:

  • Alleviating pain and neuropathy
  • Improved movement and function
  • Ability to resume activities of daily living
  • Improved quality of life

Some of the potential risks of surgery are:

  • Typical surgical risks, such as bleeding, infection, blood clots, and problems caused by anesthesia
  • Injury to the spinal cord or nerve roots, which can cause further complications such as sexual dysfunction
  • Failure to improve symptoms
  • Worsening of symptoms

What To Expect During Recovery

After surgery, above all else, your body needs time to recover. Recovery from spinal surgery requires a hospital stay so that doctors and nurses can monitor you and tell you what you need to do (and not do) to get better. After you are discharged from the hospital, recovery continues when you go home.

Some important factors that improve recovery include the following.

Treating Postoperative Pain

NSAIDs and opioid painkillers may be used to treat pain caused by your surgery. You will likely have pain at the site of the operation. You also may have pain or other sensations caused by nerves affected by the surgery.

Engaging in Limited Physical Activity

Immediately after surgery, there will be limitations on what sorts of activities you can engage in to ensure that normal healing occurs. It is important to engage in some activities such as standing and walking, often within hours of your surgery, however. Part of ensuring that normal healing takes place is making sure that you maintain the ability to move your joints and have control over your muscles.

Practicing Proper Wound Care

Nursing staff is usually responsible for ensuring that your surgical dressings and bandages are changed regularly while you are hospitalized. They also teach you what you (or your caretaker) need to know to continue changing dressings when you go home to prevent infection and allow proper wound healing.

Eating a Healthy Diet

Eating healthy is always important, but it is even more important when your body is recovering from illness and injury (including surgery). Maintaining an anti-inflammatory diet during recovery is a good idea.

Recovering Emotionally

Pain, confinement, and limited activity can contribute to or exacerbate anxiety, depression, and mood swings. It is normal to need time to recuperate from the stress of surgery, hospitalization, and recovery.

Managing Expectations

Surgery does not always go as planned, and there may be complications. Even if everything goes well, surgery may not achieve the outcomes you hoped for. But don’t lose hope: If you expect that the road to your recovery will be long and difficult, you will be prepared for what lies ahead.

Talk With Others Who Understand

MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 66,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Are you or someone you care for living with spondylitis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

A MySpondylitisTeam Member said:

I have a cage from C3 to C7. It honestly was the best thing I could have done. Dr said it would take 2 hours but it took 6.5. There were complications but I told my Dr I didn't want to know what they… read more

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Diane M. Horowitz, M.D. is an internal medicine and rheumatology specialist. Review provided by VeriMed Healthcare Network. Learn more about her here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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