Ankylosing Spondylitis, or AS for short, is a very rare condition that requires surgery. In most cases, the condition can be managed with other treatments (such as medication and exercise). However, in some severe cases, when all other treatments have failed, your doctor may decide to perform surgery. So, today, we'll talk about some of the details to help ease your fears and doubts about this condition.
Why is surgery necessary?
Not everyone with AS will need surgery. However, a very small number of people may need surgery. There are several main reasons why your doctor may consider surgery.
Simply put, surgery is only considered if the disease is so severe that you are unable to perform your daily activities. For example, consider:
- If you have unbearable pain . That is, if you cannot control the pain even after taking the strong painkillers prescribed by the doctor.
- If you are unable to walk properly due to spinal deformity, muscle weakness, or pain.
- If there is a fracture in the spine and the bone fragments are pressing on the nerves that run through the spine.
This is when surgery becomes an option. Most of these surgeries are performed under general anesthesia, meaning you are completely asleep and not aware of anything. We call this general anesthesia .
What are these types of surgeries?
There are several main types of surgeries performed for AS. Not all surgeries are performed for the same reason. Your doctor will choose the surgery that best suits your problem. Let's understand these surgeries in a simple table.
| Name of the surgery | What happens with this? | Details about the surgery |
|---|---|---|
| Laminectomy | This is the most common surgery for AS. It reduces pain that radiates down the arms and legs due to compression of the spinal nerves. | The doctor removes the 'lamina', a bone that covers the spine. This creates more space for the nerves. This surgery takes about 1-2 hours. You may be able to go home the same day. |
| Osteotomy | This is done very rarely. This surgery is done to straighten the spine in cases where the spine is severely curved and unable to stand or walk. | A section of bone is removed from the spine and the spine is realigned. This can help improve posture and reduce pain. You will need to stay in the hospital for about 5-7 days after the surgery. |
| Spinal Fusion | It is often done in conjunction with a Laminectomy or Osteotomy surgery. The removed bone stops the spine from becoming unstable and strengthens it. | The spine is stabilized using metal rods and wires. This surgery can take between 2-7 hours. You will need to stay in the hospital for 2-4 days. |
| Hip Replacement | This surgery is recommended if AS has damaged the hip joints and is causing too much pain to walk. | The damaged hip joint is removed and replaced with an artificial joint made of metal, ceramic, or plastic. You will need to stay in the hospital for 1-2 days after the surgery. |
The important thing is that it is difficult to expect that all of these surgeries will completely cure your back pain. Most of the time, they only reduce the pain caused by nerve compression and correct posture.
What are the risks of surgery?
Surgery for AS is generally successful and safe. However, with any surgery, there are some risks. It is important to be aware of these beforehand.
| Risk type | Description |
|---|---|
| Common Risks of Spinal Surgery (Laminectomy, Osteotomy, Spinal Fusion) | |
| Problems related to anesthesia | Severe conditions such as difficulty breathing, memory problems, heart attack or stroke. (These are very rare) |
| Blood clots | There is a risk of blood clots, especially in the legs. |
| Infections | Infection of the surgical wound or lung infection (pneumonia). |
| Nerve damage | There is a very small risk of damage to the spinal nerves during the surgery. |
| Pain not decreasing | Sometimes the pain may persist after surgery or be worse than before. |
| Risks of Hip Replacement Surgery | |
| Common risks | There is also a risk of blood clots and infection. |
| Dislocation | There is a small risk of the implanted artificial joint moving out of place. |
How do you prepare for surgery?
The best way to recover quickly from surgery is to prepare well for it. Here are some things you can do.
- Write down all the questions you have in mind and ask the doctor. Ask clearly what the benefits of the surgery will be, and what to expect during and after the surgery.
- Tell your doctor about all the medications you take (including over-the-counter medications).
- If you smoke, stop . Nicotine delays wound healing.
- Find out exactly how long before surgery you need to stop eating and drinking, and whether you need to stop taking certain medications.
- If you live alone, arrange for someone to help you when you get home after surgery. You may need help with things like shopping and preparing meals.
- Keep the things you need most often at home (phone, TV remote, water bottle) within easy reach.
- Remove things like rugs and cords that can get tangled while walking, and make your home safe for you to move around in .
Recovery time after surgery
Remember, it takes time to fully recover from surgery. Be patient with yourself . It's important to stay as active as possible, even if you feel weak at times.
Your doctor may recommend physical therapy or give you simple exercises to do at home. Your surgeon will explain to you what you should and shouldn't do after you get home. Ask your doctor when you can start doing more strenuous exercise.
If you had a laminectomy, you should be able to return to work in a few weeks, unless you have a job that requires a lot of lifting or walking. If you had a neck osteotomy, you will be asked to wear a collar. You may also be advised to wear compression socks to help prevent blood clots.
Most importantly: If you have signs of infection (such as fever, pus discharge), or if the pain is getting worse, call your doctor immediately.
Take-Home Message
- Surgery for ankylosing spondylitis (AS) is very rare and is only recommended in severe cases where other treatments have failed.
- There are various types of surgeries (such as Laminectomy, Osteotomy) to reduce pain, relieve nerve compression, and straighten a bent spine.
- Every surgery carries some risk, and it is essential to discuss all of these risks openly with your doctor before surgery.
- Preparing well for surgery and following the doctor's instructions after surgery are extremely important for a speedy recovery.
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