- Surgery may relieve some effects of ankylosing spondylitis (AS) in the most severe cases.
- Surgery options include laminectomy, spinal fusion, spinal osteotomy, and hip joint replacement.
- Recovery time is a few weeks to a few months. The outlook is generally favorable.
Surgery is an option for people with AS in the case of severe pain, loss of mobility, or decline in quality of life.
Surgeons have specific goals for each AS surgery. They use a few different procedure options to achieve those goals. Procedures include:
- spinal fusion
- spinal osteotomy
- hip joint replacement
The outlook for people who have these AS surgeries is good despite the risk of surgery complications or death. Minimally invasive surgery options can help reduce those risks too.
AS is a kind of inflammatory arthritis. It mainly affects the spine. The condition causes changes in the bone that lead to fractures, weakening, and changes in shape.
Surgery may relieve some effects of AS in the most severe cases. Some goals of surgery are:
- Pain relief. AS can cause severe pain. Fractures may cause the bone to develop a curve and compress nerve roots. Surgery can sometimes relieve this compression.
- Spine stabilization. Over time, AS may result in a weaker, less stable spine. Also, depending on the severity of the condition and the amount of bone and ligament removed, some surgeries, like laminectomy or osteotomy — which both involve removing bone or ligaments to help restore the spine’s normal curvature — may inadvertently destabilize it.
- Improving posture. AS can cause severe kyphosis, or rounding of the upper back or thoracic spine. Surgery may correct this, restoring more normal spinal curvature.
- Improving mobility. AS can result in the loss of hip joint mobility. Surgery can help regain some mobility in this area.
Some surgeries may be open or minimally invasive. A minimally invasive surgery — for example, those performed using robotics — is performed through small cuts instead of a large opening in the body.
Minimally invasive surgeries often promote quicker healing and less postoperative pain.
As the course of AS is different for each person, not everyone needs surgery. If you do, your doctor may suggest one of the following procedures.
During a laminectomy the surgeon removes or trims portions of the spinal vertebrae. This can relieve pressure on the nerve roots and spinal cord. It should help relieve pain.
A laminectomy may be minimally invasive or a full open-spine surgery.
Spinal osteotomy refers to a number of surgeries used to change the spinal curvature. The goal is to relieve pain and improve quality of life.
For someone with AS, osteotomy might be an option where the spinal curvature is pronounced, such as in cases of severe kyphosis. The surgeon may cut and realign portions of the spinal bone so the spine is straighter.
During spinal fusion the surgeon fuses two vertebrae together. They place a graft of bone between two vertebrae that helps them eventually grow together.
Spinal fusion is performed to help stabilize the spine, and thus may be combined with other surgeries. This procedure can also be helpful when movement of vertebrae is the source of pain.
Hip joint replacement
In a hip joint replacement, portions of the hip bone or joint are taken out and replaced with a prosthesis.
A doctor may recommend hip replacement when AS causes mobility limitations in the joints. The hip joint replacement may be a minimally invasive procedure.
Surgery is often the last line of treatment for AS. Most people with AS never need surgery. However, doctors may recommend surgery if one of the following apply:
- severe, persistent pain
- severe limitation of mobility
- reduction in quality of life
The type of surgery you may have will depend on how AS affects you. For example, a laminectomy may help relieve pain, or an osteotomy may help to straighten the spine. A hip replacement may improve hip joint mobility and reduce hip pain.
The cost of surgery for AS varies significantly between hospitals, regions, and your specific medical needs. Your insurance company may also cover all or part of the cost of the procedure.
The overall cost may depend on factors like the complexity of the procedure, how long you stay in the hospital, and any complications that arise.
A 2015 study that looked at Medicare data from 2012 suggest that costs for upper back or thoracic spine surgery can range from $11,000 to $25,000, while surgeries involving the lower spine may range from $20,000 to $37,000.
Recovery time, postsurgery, will depend on the type of procedure you’ve had and your personal health.
Most people spend a few days to a week in the hospital immediately following spine surgery. Some will be up and walking with assistance on the same day.
Depending on the type of surgery, full recovery can take anywhere from a few weeks to a few months. During that time, your healthcare team will closely monitor your progression.
You may need physical therapy to regain mobility. Many people may need to wear a brace for several weeks. You’ll likely need follow-up X-rays to make sure the area is healing correctly.
It typically takes less time to recover from a minimally invasive procedure than open-spine surgery.
Overall, surgery can have very successful outcomes for people with AS who are in severe pain, are experiencing severely limited mobility, or have significantly reduced quality of life.
The rate of success for AS spine surgeries may vary depending on the severity of the condition and the person’s overall health.
As with any surgical procedure, it’s important to remember that there are also many potential risks to consider. They include:
- potential need for revision
Another factor that can affect the outcome is how closely the person sticks with their postsurgical care plan, including physical therapy and regular doctor visits to monitor any changes.