Can Surgery Help Ankylosing Spondylitis?

Ankylosing spondylitis, a rare form of arthritis, mainly affects the sacroiliac joints between the bones of the pelvis, spinal column, ribcage, neck, and skull bones. Most people with ankylosing spondylitis will never need to have surgery for the condition. If they ever do, it may include joint replacement, fracture stabilization, or spinal surgery (osteotomy, spinal fusion instrumentation, spinal decompression).

Ankylosing spondylitis is a chronic, inflammatory autoimmune disease that is a rare form of arthritis. It mainly affects the sacroiliac joints between the bones of the pelvis, and the axial skeleton, which includes the spinal column, ribcage, neck, and skull bones. 

Surgery is rarely used to treat ankylosing spondylitis and most patients will not require surgical intervention. When surgery is needed, it may include:

• Joint replacement to help with severe pain or joint damage 
• Fracture stabilization 
• Spinal surgery 
  • Osteotomy
    • The bone is cut to shorten, lengthen, or alter alignment
    • Can correct posture, but does not fully restore mobility and flexibility
  • Spinal fusion instrumentation
    • Stabilizes the spine and may be used in people with spinal fractures or if significant bone has been removed during an osteotomy
    • Two or more vertebrae are fused together
    • Does not allow for movement of that part of the spine, but is used to fix an unstable spine
  • Spinal decompression
    • Used when nerves are being pinched due to excess bone tissue or fractures
    • The most common type of spinal decompression surgery is a laminectomy, in which the lamina of the vertebrae is removed to relieve pressure on the nerves

Since most patients do not need surgery, treatment for ankylosing spondylitis usually involves a combination of exercise and physical therapy, healthy lifestyle changes, and medication.

Physical therapy and exercise used to treat ankylosing spondylitis include:

• Exercises
  • Breathing exercises 
  • Cardiovascular 
  • Core strengthening
  • Dynamic movements
  • Fall-prevention exercises 
  • Isometric strengthening
  • Stretching
• Posture training to help prevent the spine from becoming “frozen” 

Lifestyle modifications to help manage ankylosing spondylitis include: 

• Safety measures to minimize accidents caused by limited mobility 
  • Always wear seatbelts in motor vehicles
  • Avoid contact sports and high-impact activities if the spine is inflexible
  • Limit alcohol
  • Modify the home to decrease the risk of falls
  • Sleep on a thin pillow to help avoid developing deformities of the neck
  • Use narcotics and sleeping pills with caution or avoid them entirely
• Eat a healthy diet with anti-inflammatory foods
  • Consume foods such as fruits, vegetables, whole grains, fatty fish, and extra virgin olive oil  
  • Limit red meat, sugar, and processed foods
• Don’t smoke
• Pace yourself
  • Take breaks throughout the day to manage fatigue
• Support groups to help patients cope

Medications used to treat ankylosing spondylitis include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used medications for or pain and stiffness
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
  • Celecoxib (Celebrex) 
  • Diclofenac (Flector, Cambia, Zorvolex)
  • Indomethacin (Indocin, Tivorbex)
• Biologics may be used if NSAIDs don’t work well
  • Tumor necrosis factor-α (TNF-α) antagonists 
    • Adalimumab (Humira)
    • Certolizumab pegol (Cimzia)
    • Etanercept (Enbrel)
    • Golimumab (Simponi)
    • Infliximab (Remicade)
• Anti-interleukin 17 therapy 
  • Ixekizumab (Taltz) 
  • Secukinumab (Cosentyx) 
• Sulfasalazine (a DMARD) and methotrexate for arthritis symptom relief
• Corticosteroid injections for swollen, painful joints 
• Opioids (narcotics) to treat pain