When is Surgery Appropriate for a Person With Ankylosing Spondylitis?

Health Writer
Medically Reviewed

Most people who live with ankylosing spondylitis (AS) do not require surgery. That’s because the array of medications, when combined with exercise and physical therapy, control the condition well enough to prevent severe joint degeneration and deformity. Sometimes, however, spine and hip damage is so severe that mobility and quality of life are seriously compromised. In those instances, a board-certified orthopaedic surgeon who is trained and highly experienced in correcting spinal fusion or replacing a severely compromised hip should be consulted. Hip replacement is more frequently undertaken in people with AS than corrective spinal surgery. Both procedures require a course of rehabilitative physical therapy to ensure optimal function following the procedure.

Hip replacement

People with AS frequently experience severe degenerative damage to the tissue and bone in the hip. Few recent studies focus on outcomes of hip replacement in people with AS. Goodman and colleagues, however, compared results in hip replacements for people with OA and people with AS two years postoperatively. Although the AS patients had worse comorbidities at the time of surgery than the patients with OA, two years after the procedure there was no difference in level of pain or function.

Spine surgery to restore posture

Ankylosing spondylitis (AS) can cause the vertebrae to fuse, resulting in a frozen bent-over position. A permanently fused spinal column prevents a person from standing straight or being able to look ahead. Instead, the person is forced to look downward.

Surgery can help, but the procedure carries risk. Anyone considering surgery should choose a board-certified orthopaedic surgeon who specializes in correcting this type of deformity and who has performed the operation many times. The procedure has an 80 percent success rate according to Dr. Jeffrey T. Nugent, an orthopaedic surgeon. To straighten the neck curvature, bone must be removed from the base of the neck, and then the remaining vertebra fused.

Talk to physicians, family, and friends before proceeding with surgery. If possible, talk to others who have already had the surgery being considered. Ask what the procedure and recovery were like and whether the outcome has significantly improved quality of life. Get multiple perspectives and weigh the risks and benefits before deciding to proceed.