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.
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.
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:
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.
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.
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 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.
Spinal osteotomy involves removing portions of bone in the spine to separate fused vertebrae and straighten abnormal curvature.
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 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.
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:
Some of the potential risks of surgery are:
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.
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.
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.
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 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.
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.
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.
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