Ankylosing Spondylitis Surgery: Types, Risks, and More
Rheumatic ConditionsAnkylosing Spondylitis

Ankylosing Spondylitis Surgery: What You Should Know

Learn when and why you might need surgery for ankylosing spondylitis.
Ankylosing Spondylitis Surgery: What You Should Know
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Published on October 15, 2024
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Most times, ankylosing spondylitis (AS) — a type of inflammatory arthritis — can be effectively treated with medication and physical therapy. But occasionally, surgery may be needed.

It’s most often considered in cases when other treatments don’t work.

 For example, you and your doctor might consider surgery if your pain level gets to the point where you need excessive amounts of pain medications, says Aly Cohen, MD, an integrative rheumatologist based in Princeton, New Jersey. It could also be necessary if you’ve had an injury, such as a fracture.
To decide if surgery is the right option for you, your healthcare provider will assess your overall health, how AS is affecting your bones and joints, and weigh the risks and benefits of surgery for you.

Here’s what to know about when AS surgery may be warranted, types of AS surgery, and more.

When Is Ankylosing Spondylitis Surgery Needed?

“In most cases, orthopedic surgeons will perform surgery in AS patients to stabilize fractures,” says Michael Gerling, MD, an orthopedic spinal surgeon in New York City.

You may need surgery if severe AS pain doesn’t improve enough with medications or exercise, or when spinal pain comes with persistent neurological symptoms like numbness or, in more serious cases, weakness, loss of motor function, or loss of bowel or bladder control, Dr. Gerling adds.

Here are some instances when you and your doctor may want to consider surgery.

Kyphosis

If you have AS, you may experience severe kyphosis, or a forward rounding of the upper spine. More than 30 percent of people with AS have kyphosis.

 “[This may] require spinal surgery to correct posture and improve quality of life,” says Gerling.

Spinal Fracture

Because of rigid and brittle bones that accompany AS, fractures of the spine happen four times more often in people with AS than they do in people without AS. These fractures may require surgery.

Severe Hip Joint Damage

About one-quarter to one-third of people with AS experience damage to one or both hip joints. If the damage is severe or causes too much pain, you may need hip replacement surgery.

Spinal Cord Injury

The bones of the spine surround your spinal cord — the main nerve pathway from your brain to the rest of your body. When these bones get injured, this also puts your spinal cord at risk, and that may require surgery.

Types of Ankylosing Spondylitis Surgery

The type of surgery you need for AS may depend on your symptoms or, if you’ve been injured, the type of injury you have.

Laminectomy

A laminectomy relieves pressure on your nerve roots — the spot where nerves branch away from your spinal cord. During this procedure, your surgeon removes part of a bone in the spine, called the lamina, that’s putting pressure on your nerves. This surgery involves a small incision in your back and is considered minimally invasive, lasting one to two hours.

Osteotomy

Spinal osteotomy means removal of spinal bone material. For AS, spinal osteotomy is used to correct abnormal spine curves, lessen pain, and improve your quality of life.

Depending on your spinal curve, you may receive one of the following types of osteotomy:

  • Closing-Opening-Wedge Osteotomy (COWO) Removal and placement of bone material at various places along the spine to correct curve abnormalities
  • Poly-Segmental Wedge Osteotomy (PWO) Removal of bone at several points along the spine to correct over-curvature
  • Monosegmental Closed-Wedge Osteotomy (CWO) Curve correction through surgery on one vertebra, or back bone

Fusion

During spinal fusion, two or more vertebrae (back bones) are fastened together using screws and rods, with bone material (a bone graft) placed between them to encourage the vertebrae to fuse into one bone.

This procedure can be more involved, taking several hours, and can be performed through the front (anterior), back (posterior), or side (lateral) of the body.

Hip Replacement

Total hip replacement, the most common surgery for people with AS, involves replacing damaged hip cartilage and bones with prosthetics. The top of your femur (thigh bone) is removed, and a metal stem and ceramic ball are fitted to the bone. This surgery takes about an hour or two to complete.

Risks and Side Effects of Ankylosing Spondylitis Surgery

Any surgery comes with certain risks. In general, AS surgery often has the following risks:

  • Anesthesia-related complications
  • Infection
  • Excessive bleeding
For laminectomy, risks and complications could also include blood clots in the lungs or legs, spinal cord injury, or nerve root injury.

Spinal osteotomy surgery comes with a small risk (5 percent) of postoperative neurological complications like numbness.

Spinal fusion can come with risks like implant failure and surgical site infection. Posterior fusions and being older than 70 may put you at a higher risk of complications, according to one study of 166 patients with AS.

The most common complication after a hip replacement is heterotopic ossification — bone tissue growth in areas that shouldn’t contain bone. This can occur in up to 74 percent of cases.

 People with AS also have a higher risk of anemia (a low red blood cell count) and infections after hip replacement.

How Successful Is Ankylosing Spondylitis Surgery?

AS surgery success depends on many factors, like your health at the time of surgery and the type of surgery you have. In general, people with AS are more likely to have optimal results if they’re up for the post-op recovery period. “[They] want to be in good enough shape to rehab after a surgery,” says Cohen. “You need to have enough muscle strength and health to recover.”

Postoperative care — including pain management and regaining mobility soon after surgery — also plays a significant role in whether you have a successful outcome.

In general, laminectomies have a success rate of 90 percent, and about 75 percent of people who undergo a laminectomy report being satisfied with the outcome.

Spinal osteotomies have a high success rate (around 80 percent) for preventing disease progression, lowering pain levels, improving mobility, and easing breathing and digestion issues.

Hip replacement surgery for AS can also lessen pain and increase long-term mobility after recovery. These results, though, are based on case studies and haven’t been assessed in large-scale research.

For spinal fusion, results are typically best when a spinal fracture isn’t too severe.

 “AS patients do very well after spinal surgery,” says Gerling. “They are bone formers and therefore stabilize very quickly after corrective surgery.”

The Takeaway

  • AS can usually be managed through medication and physical therapy, but occasionally, it can require surgery.
  • Options like laminectomy, osteotomy, spinal fusion, and hip replacement each offer different benefits, but also carry certain risks.
  • Talk with your healthcare provider to see if surgery might be the next step for your AS management.

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