Ankylosing spondylitis is a type of arthritis that primarily affects the spine. The condition can also cause inflammation, pain, and stiffness in other parts of the body, such as the hips, knees, ribs, and shoulders. Doctors may recommend surgery for various reasons, including severe pain and reduced mobility.
Most people with ankylosing spondylitis (AS) manage the condition using a combination of medication, exercise, and complementary treatments. However, some people may require surgery to help alleviate their symptoms.
This article outlines when surgery is necessary for AS and discusses the types of surgery available. It also looks at the benefits, risks, possible complications, and financial costs of surgery.
Ankylosing spondylitis (AS) does not always require surgical treatment. In many cases, a person can manage the condition using one or more of the following:
- Medications: A doctor may recommend one or more of the following medications to help manage AS:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Drugs that help to reduce inflammation and pain.
- Corticosteroids: Drugs that help to suppress inflammatory responses. A doctor may recommend corticosteroid injections directly into affected joints to reduce localized inflammation.
- Biologics: These refer to
drugs or treatmentscontaining proteins or other substances originating from a natural source, such as a human, animal, or microorganism. They are a special type of disease-modifying anti-rheumatic drugs (DMARDs), which can help treat arthritic conditions.
- Physiotherapy and exercise: Regular stretching and low-impact sports can help to keep the spine mobile and improve posture.
- Complementary therapies: People with AS may also benefit from complementary therapies, such as:
- acupuncture to alleviate pain
- massage to alleviate pain and improve circulation
- yoga to help maintain joint flexibility
- use of a transcutaneous electrical nerve stimulation (TENS) machine, which uses mild electrical currents to help alleviate pain
A doctor may recommend surgical treatment for AS if a person experiences one or more of the following symptoms:
- Severe pain: The person experiences pain that does not respond to over-the-counter (OTC) or prescription pain relief.
- Reduced mobility: The person experiences severe mobility impairment that reduces their quality of life.
- Spinal fracture: The person has sustained a spinal fracture or is at increased risk of developing a spinal fracture.
- Spinal fusion: The condition has caused two or more cervical vertebrae to fuse, limiting motion in the neck or back.
- Severe kyphosis: The condition has caused severe kyphosis, a severe curvature of the spine in the upper back.
A doctor may also recommend surgery if a person cannot carry out day-to-day functions, such as working or driving.
Below are some different types of surgical procedures that may help to treat AS.
A laminectomy, or
A surgeon can perform a laminectomy as an open surgery or as a minimally invasive procedure. The latter involves using specialized equipment to access the spine through small surgical incisions.
A spinal osteotomy is a surgical procedure that involves cutting and reshaping bones to straighten the spine. This procedure may be suitable for people who have a severe spine curvature that causes pain and reduces mobility.
The procedure may differ according to the location of the spinal curve and the bones that the surgeon needs to operate on.
Spinal fusion surgery involves fusing two or more vertebrae. This procedure can help to alleviate pain caused by mechanical pressure between the vertebrae or between the vertebrae and the spinal cord. It can also help to stabilize the spine.
A surgeon will fuse the vertebrae using a bone graft from the person’s own body or a donor. The surgeon will then use rods, wires, and screws to hold the vertebrae in place while they fuse.
Following surgery, a person will need to wear a back or neck brace to ensure the bones heal in the correct position.
Hip joint replacement
Hip joint replacement surgery involves removing the hip joint and replacing it with an artificial joint. This procedure aims to improve mobility in people who have sustained severe damage to the hip joint.
A surgeon may perform the procedure as an open surgery or as a minimally invasive procedure.
A person who receives surgery for AS may experience the following benefits:
- Pain relief: Surgery may help to alleviate severe pain caused by spinal compression, joint damage, or bone fractures.
- Increased mobility: Surgery can help to improve the range of motion in the joints.
- Improved posture: Following surgery, a person may find that they can sit or stand with a straight back or maneuver themselves into positions they previously found too difficult.
- Spinal stability: Some surgeries may help to stabilize the spine.
Some potential risks and complications associated with spinal surgery include:
- infection at the incision site
- damage to blood vessels
- blood clots
- allergic reactions
- spinal fractures
- nerve damage
The cost of surgery for AS varies depending on several factors, including:
- where a person lives in the United States
- the experience of the surgeon carrying out the procedure
- the complexity of the procedure
- the time it takes the person to recover
- whether the person experiences complications that require further treatment
A doctor will only recommend surgical treatment for AS if they deem the procedure a medical necessity. This means that a person’s insurance will likely cover the cost of the surgery.
A 2015 study used Medicare data from 2012 to investigate differences in the cost of spinal surgery according to patients’ geographic locations within the U.S. The data suggests the average cost of spinal surgery on the upper back was $13,899, and the surgery on the lower back had a total average price of $25,858.
Recovery time will vary depending on the type of surgery a person receives and their overall health.
Following surgery, a person will require regular checkups with their healthcare team to ensure they are making good progress.
Following surgery, a person will receive advice about caring for their surgical wound and how to monitor the wound for signs of infection.
A person should contact a doctor if they experience any of the following signs of infection:
- redness or swelling at the site of the surgical wound
- severe pain around the wound
- discharge from the wound
People should also be aware that surgical procedures can increase the risk of blood clots. A person should seek immediate medical attention if they experience any of the following possible signs of a blood clot:
AS is a type of arthritis that causes inflammation of the individual spinal joints, where vertebra, intervertebral discs, tendons, and ligaments are located. The condition can cause pain and can reduce joint mobility. Severe AS can affect a person’s ability to carry out day-to-day tasks.
Not everyone with AS will require surgery for the condition. A doctor will typically only recommend surgery if a person experiences severe or persistent pain, has severe mobility issues, or reduced quality of life.
For people who do receive surgery for AS, the outlook is generally favorable. However, people should be aware of the risks and complications of surgery. Anyone who experiences complications following surgery should seek immediate medical attention.