When severe pain, stiffness, or changes in the spine from ankylosing spondylitis (AS) make daily tasks difficult, your doctor may recommend spinal surgery to help restore mobility and improve quality of life. While most people with AS manage symptoms with medication and physical therapy, understanding when surgery might be necessary can help you make informed choices. Here’s what to know about spine surgery for ankylosing spondylitis.

What Is the Treatment for Ankylosing Spondylitis?

Ankylosing spondylitis is an inflammatory condition where the bones in the spine fuse together over time. This can cause stiffness and pain in the back, hips, and neck. The goal of treatment for AS is to manage pain and prevent complications. Some of the treatments for AS include:

• Physical therapy
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Biologics
• Janus kinase (JAK) inhibitors

Since many people can manage their symptoms with medications, surgery isn’t usually recommended for people with ankylosing spondylitis. However, it may be recommended for certain people.

When Is Spinal Surgery Appropriate for Ankylosing Spondylitis?

Most people with ankylosing spondylitis manage their symptoms with medications that reduce inflammation and pain. These treatments can help slow the disease and maintain mobility for many years. For some people, AS can progress despite these treatments, leading to serious complications that interfere with daily life. In these cases, spinal surgery may be necessary.

Spinal surgery is typically considered when:

• The spine becomes severely curved or stiff.
• There’s damage to nerves that causes pain or weakness.
• The spine becomes unstable and can no longer support normal movement or posture.
• A fracture (break) occurs in the spinal bones and threatens nerve function or spinal stability.

Below are some advanced symptoms of AS that may lead a doctor to recommend surgery.

Kyphosis

One common reason for spine surgery in AS is kyphosis, a condition where the upper spine bends forward too much. This forward curvature can become so extreme that a person may not be able to lift their head and look straight ahead (sometimes called hyperkyphosis).

When kyphosis reaches this stage, it can:

• Affect breathing and digestion
• Cause chronic neck or back pain
• Lead to difficulty sleeping, walking, or maintaining balance

Surgery can help reduce these symptoms by straightening the spine and improving a person’s ability to stand more upright.

Nerve Damage

In some cases, AS causes parts of the spine to press on nearby nerves, especially as bones change shape or fuse. This pressure can result in nerve damage.

If symptoms don’t improve with physical therapy or medication, spinal surgery may be required to relieve pressure on the nerves and prevent permanent damage.

Spinal Fractures

People with AS are more likely to experience spinal fractures because the disease causes bones in the spine to become brittle and fused together. Even a minor fall or sudden movement can lead to a fracture — especially in the neck or upper back. These fractures can be dangerous and may lead to:

• Sudden, severe back or neck pain
• Nerve damage, if the broken bone presses on the spinal cord
• Difficulty walking

In these situations, surgery may be necessary to stabilize the spine, realign the bones, and prevent further injury to the spinal cord or nerves. This might involve inserting rods, screws, or plates to hold the spine in place while it heals.

Types of Spinal Surgery for Ankylosing Spondylitis

The type of surgery depends on the cause, symptoms, and which parts of the spine are affected. In many cases, surgery is used to straighten the spine, reduce pressure on nerves, or keep the spine stable.

Here are the main types of spinal surgery used to treat AS.

Spinal Fusion

In AS, parts of the spine can become weak, leading to spinal instability and increasing the risk of fractures. Spinal fusion helps fix this by permanently connecting two or more vertebrae. The surgeon may use a bone graft (a small piece of bone from either you or a donor) to help the bones grow together naturally over time.

To keep the spine stable while it heals, the surgeon will place metal screws, rods, wires, or plates along the spine. These materials act like internal scaffolding, holding the bones in the correct position.

Osteotomy

Spinal osteotomy is a surgical procedure that helps straighten a spine that has become too curved due to AS. In an osteotomy, the surgeon carefully cuts and removes a small wedge of bone from one or more vertebrae. This creates space to realign the spine, allowing the head and upper body to return to a more natural, upright position. Metal hardware (like screws and rods) is often used to hold everything in place while the bones heal.

Osteotomy is typically used when someone has severe kyphosis that isn’t improving with nonsurgical treatments.

Laminectomy

Some people with AS have added pressure on the spinal cord or spinal nerves. This can happen when inflammation, bone growths, or shifting vertebrae press on the spaces where nerves pass through.

To relieve this pressure, doctors may recommend a form of decompression surgery known as laminectomy. During this procedure, the surgeon removes part of the bone at the back of the vertebra, called the lamina. This opens up more space for the spinal cord and nerves, which helps reduce pain and other nerve-related symptoms.

What To Expect During Recovery From Ankylosing Spondylitis Surgery

Recovering from spinal surgery for ankylosing spondylitis takes time, patience, and support. But knowing what to expect can make the journey easier. Healing begins in the hospital but continues long after you return home. Everyone’s recovery timeline is different. Here’s what you may experience during your recovery and how to give your body the best chance to heal well.

Recovery in the Hospital

After your surgery, you’ll likely stay in the hospital for a few days. During this time, your care team will:

• Manage your pain
• Monitor your breathing, movement, and nerve function
• Help you start gentle activity, like standing or walking
• Plan for your physical recovery

You’ll be closely watched to make sure everything is healing as expected. Nurses and physical therapists will guide you on how to move safely and help you understand what you can and can’t do during this early stage.

Managing Your Pain

It’s normal to feel pain after surgery — especially near the area where the operation was done. You might also feel tingling or burning if nearby nerves were affected. To manage this, your doctor may recommend a combination of over-the-counter or prescription medications. To limit your pain, make sure you take the medication exactly as your doctor prescribed.

Engaging in Gentle Movement and Activity

Even though rest is important, moving your body is also crucial for healing. Your care team will encourage you to:

• Stand up from a chair or get out of bed
• Change your clothes
• Do exercises to strengthen your back muscles

The goal is to keep your joints moving and muscles active without overdoing it. When you return home, you’ll likely need to avoid bending, lifting, or twisting for several weeks. Your doctor or physical therapist will give you clear guidance on what’s safe.

Practicing Proper Wound Care

While you’re in the hospital, staff will take care of your bandages and make sure your incision is clean and dry. Before you leave, they’ll show you (or your caregiver) how to:

• Change dressings safely
• Spot signs of infection, like discoloration, swelling, or drainage
• Keep the area clean and dry

Proper wound care helps prevent infection and supports healthy healing.

Taking Care of Your Mental Health

Surgery can be stressful — not just on your body but on your emotions too. It’s completely normal to feel anxious, frustrated, or even down during recovery, especially if you’re in pain or feeling stuck inside.

To take care of your mental health, be sure to:

• Talk to a therapist or counselor if you feel overwhelmed.
• Stay connected with friends and family for support.
• Practice deep breathing, meditation, or light stretching as you’re able.

Recovery isn’t just physical — your mental health matters too.

Setting Realistic Expectations

Even with a successful surgery, results aren’t always immediate. You may need months of recovery and physical therapy to notice the full benefits. And sometimes, complications or setbacks happen. Try to be patient with yourself. Healing isn’t a straight line, and it’s normal to have ups and downs. Preparing for a slow and steady recovery will help you stay motivated and focused on long-term improvement.

Recovering from spinal surgery is a big journey, but you don’t have to go through it alone. With a supportive medical team, good self-care, and realistic expectations, many people with AS regain mobility, improve their posture, and feel stronger over time. Remember, healing is progress, even if it feels slow.

Talk With Others Who Understand

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

Have you had spinal surgery for ankylosing spondylitis? What surgery did you have? Share your experience in the comments below, or start a conversation by posting on your Activities page.