Surgery for ankylosing spondylitis (AS) is very rare. Your doctor may recommend it if your condition is severe and if other treatments haven’t helped enough.
Reasons for Surgery
Most people with AS never need an operation. But sometimes, surgery may be necessary. Your doctor may recommend surgery if you:
- Can’t walk because of weak muscles, deformity, or pain, even if you’re on pain medication
- Are in extreme pain
- Have bone fractures that push on your spine and nerves
For most AS surgeries, your doctor will give you medication to put you to sleep (general anesthesia).
Types of Surgery
Laminectomy. This is the most common operation for AS. It takes the pressure off the nerve roots and lessens the pain from compressed nerves. The doctor removes the lamina, which is the bone that covers the spinal cord. This makes more space around the spine and allows it to move more easily. A laminectomy sometimes may also leave your spinal column less stable. If so, your doctor may add a bone that will fuse, or grow together, with your spine. They also may insert a metal rod for added support.
A laminectomy could help with the pain that runs along your arms and legs. But it likely won’t offer any benefit with back pain.
How it’s done: Your surgeon makes a small cut through the skin in your back and pushes your muscles aside. This procedure lasts 1-2 hours. You may go home the same day as the surgery.
Osteotomy. This is done in very rare cases when your spine curves so much that it hinders your movement or keeps you from standing straight up. Your surgeon removes some of the bone and realigns the spine to help correct your posture, reduce pain, and keep organs like the heart and lungs from pressing on one another. The surgery may let you walk and move easier, but it may not make you fully mobile.
Studies have found few major complications with osteotomy.
How it’s done: Your surgeon makes a small cut in your back and places screws in your spine where a rod will be set. This is to take pressure off the spine while it heals. Your doctor will then remove bony projections along the vertebrae as well as the lamina in order to move the spine into the right position. Finally, you will receive a grafted bone that will grow along with the vertebrae. You may need to stay in the hospital for 5-7 days after an osteotomy.
Spinal fusion. This procedure is often done with a laminectomy or an osteotomy. With these two surgeries, the spine may be less stable due to bone loss or the extra space in the spinal column. A spinal fusion helps you heal faster so you recover more quickly.
How it’s done: the surgeon uses rods, bars, and/or wires to stabilize the spine. It can take 2-7 hours, and you can expect to stay in the hospital for 2-4 days.
Hip replacement. This isn’t commonly done for AS. Your doctor may recommend it if arthritis has damaged your hip joints so that you have trouble walking and moving and are in pain even with medication. Artificial replacement joints may restore some, but not all, of your range of motion.
How it’s done: Your doctor replaces the damaged joints with metal, ceramic, or hard plastic to form an artificial hip. In some cases, it may be done robotically. The operation may last several hours. You may stay in the hospital for 1-2 days.
Risks With Surgery
The different types of operations for AS are safe and work well. But any surgery carries chances for complications.
Spinal surgeries. Possible risks with laminectomy, osteotomy, and spinal fusion may include:
- Problems with general anesthesia, including issues with memory and breathing, or heart attack or stroke
- Blood clots
- Lung problems, such as pneumonia
- Unstable implants that move around
- Spinal nerve damage
- Pain that does not go away or is worse than before surgery
- Added stress on your spine that may cause it to degenerate more quickly
Hip replacement surgery. This has a high rate of success. Almost everyone sees some relief from pain and stiffness. Possible risks include:
- Blood clots
- The hip moving out of place (dislocation)
How to Prepare for Surgery
The best way to recover from surgery is to prepare for it. Here are ways you can get ready.
- Bring a list of all your questions to your surgeon.
- Ask what your surgery may do for you, and what to expect during and after the procedure.
- Tell your doctor about any medications you take, even over-the-counter ones.
- If you smoke, quit. Nicotine slows healing.
- Ask how long before your surgery you should stop eating and drinking and taking certain medications.
- If you live alone, arrange for someone to help shop, prepare meals, and offer other help when you return home.
- Gather items you need such as phones and TV remotes in one place for easy reach. If needed, rearrange your furniture to make it easy to get around. Remove any trip hazards.
Recovering From Surgery
Remember that it takes time to bounce back. Be patient with yourself. You may not feel up to it, but it’s important to move as much as you’re able.
Your doctor may recommend physical therapy or suggest exercises to do at home. Your surgeon will tell you what you can and can’t do once you get home. Ask your doctor when you can start on more intense exercise.
If you’ve had a laminectomy, you may be able to go back to work in a few weeks if your job doesn’t involve much lifting or walking. If you had an osteotomy on your neck, your doctor may want you to wear a collar. Compression socks may help prevent blood clots.
Call your doctor if you notice any infections or if your pain gets worse.