Ankylosing Spondylitis, Orthopedic Perspective (cont.)
In most cases, surgery is not necessary for people with AS. Surgery is performed to decrease the risk of complications of AS. Surgery for AS does not cure the disorder.
- People with significant involvement of the neck (cervical spine) or upper back (thoracic spine) may have significant impairment in the line of sight, eating, and psychological well-being. These people may benefit from a realignment of the spine to allow the person to straighten the head and look forward (extension osteotomy). This procedure is difficult and has multiple associated risks, but if successful, it allows the person to return to a more functional life.
- The bones of the spine can grow together, preventing motion in the neck and back (autofusion). Patients that develop an increase in the amount of motion in the neck or back should be treated cautiously and should be considered to have developed a spinal fracture. X-rays are often obtained to determine if a fracture has occurred. In this case, surgery might be necessary to reduce the risk of injury to the nerves or spinal cord (neurologic complications).
- People who develop bowel or bladder dysfunction should be evaluated immediately with an MRI to assess for possible cauda equina syndrome caused by narrowing of the spinal canal (spinal stenosis). This is an emergency requiring surgery within 48 hours to prevent permanent loss of function.
- People with significant involvement of the hips or knees may need hip or knee replacement surgery as the disease worsens and they develop less motion and more pain. Excess new bone formation may occur after surgery and gradually decrease joint function so that another surgery is required.