Ankylosing Spondylitis Surgery

By: Judith Frank, MD
March 6, 2008

The majority of patients suffering from ankylosing spondylitis do not need to have surgery; however, surgery is an option for patients suffering from severe ankylosing spondylitis and spinal deformities related to it. There are two types of surgery that may be an option for severe cases, depending on the patient’s clinical situation and symptoms: joint replacement or osteotomy.

Joint replacement

For the hip, shoulder and knee problems related to this form of arthritis, joint replacement surgery can allow people to regain the use of joints that have been affected by ankylosing spondylitis. Hip, shoulder and knee replacement are becoming increasingly successful for people with severe pain and limited mobility in those joints.

Osteotomy

Surgical correction of the spine itself is also possible to address pronounced deformities such as a humpback or swayback, or the chin-on-chest posture characteristic of patients with advanced ankylosing spondylitis.

Indications that a patient may benefit from this type of surgery include:

• Severe, unremitting pain that is not sufficiently relieved by non-surgical care
• Neurological deficits
• Spinal instability
• Decreased ability to hold the head up and see horizontally
• Difficulty in completing everyday activities due to spinal deformity

There are a wide variety of surgical approaches and procedures that may be used, and different areas of the spine may be operated on, depending on the patient’s individual situation. Factors that will be considered include: the angle and location of the deformity, degree of spinal stability, degree and type of neurological deficits, as well as the individual patient’s other health factors and symptoms.

While rare, a procedure such as an osteotomy may be an option. This involves cutting through the spinal column so that it can be realigned to a more vertical position in order to significantly improve the posture of a patient. After the bone is realigned in a more vertical position it will be allowed to heal in that new position. Typically, spinal instrumentation (such as pedicle screws) and a spinal fusion are combined with an osteotomy to stabilize the spine during healing and foster growth of new bone to fuse the spine in the new position.

The area of the spine that is operated on will vary depending on the type of deformity and symptoms, and for some patients several sections of the spine may need to be surgically corrected. For example, for severe chin-on-chest deformity, surgical correction in the area where the neck meets the upper spine is typically done.

For patients who have not benefited from other forms of treatment, surgery can provide relief from some of the physical and associated emotional difficulties of spinal deformity caused by advanced ankylosing spondylitis. The decision to have surgery can be a difficult one, requiring patients to weigh the risks and benefits carefully.

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