Key takeaways
- Surgery might be considered for those with severe ankylosing spondylitis (AS) to alleviate pain, improve mobility, or enhance overall quality of life.
- Surgical options for AS include laminectomy, spinal osteotomy, spinal fusion, and hip joint replacement, each addressing specific issues caused by the condition.
- AS surgery costs vary, influenced by factors like the procedure’s complexity and hospital stay. Recovery generally involves physical therapy and monitoring, with minimally invasive approaches often leading to quicker recovery times.
Surgery may be an option for people with ankylosing spondylitis (AS) who have severe pain, loss of mobility, or decline in quality of life.
Surgeons have specific goals for each AS surgery. They use a few different procedure options to achieve those goals. Procedures can include:
- laminectomy
- spinal fusion
- spinal osteotomy
- hip joint replacement
The outlook for people who have these AS surgeries is good despite the risk of surgery complications. Minimally invasive surgery options can help reduce those risks too.
Keep reading to learn more about the types of surgery for AS, who can benefit from them, and the possible benefits and risks.
AS is an inflammatory arthritis that mainly affects the spine. It starts with inflammation in the vertebrae and the sacroiliac joints, which causes pain and stiffness. This chronic inflammation can lead to bony growths along the corners of the vertebrae that can cause fusion and make the spine inflexible.
AS can lead to kyphosis, weakening, changes in shape, and decreased chest expansion.
Surgery may relieve some effects of AS in the most severe cases. Some goals of surgery include:
- Pain relief: AS can cause severe pain. Fractures may cause the bone to develop a curve and compress nerve roots. Surgery can sometimes relieve this compression.
- Spine stabilization: Over time, AS may result spine weakness and instability. Also, depending on the severity and the amount of bone and ligament removed, some surgeries, like laminectomy or osteotomy, may inadvertently destabilize it. These surgeries both involve removing bone or ligaments to help restore the spine’s typical curvature.
- Improving posture: AS can cause severe kyphosis, or rounding of the upper back or middle back (thoracic spine). Surgery may correct this, restoring a more normal spinal curvature.
- Improving mobility: AS can result in the loss of hip joint mobility. Surgery may help regain some people with AS mobility in this area.
Some surgeries may be open or minimally invasive. A minimally invasive surgery, such as those performed using robotics, is performed through small cuts instead of a large opening in the body.
Minimally invasive surgeries often promote quicker healing and less postoperative pain.
As the course of AS is different for each person, not everyone needs surgery. If you do, your doctor may suggest one of the following procedures.
Laminectomy
During a laminectomy, the surgeon removes or trims portions of the spinal vertebrae. This can relieve pressure on the nerve roots and spinal cord. It can help relieve pain.
A laminectomy may be minimally invasive or a full open-spine surgery.
Spinal osteotomy
Spinal osteotomy refers to a number of surgeries used to change the spinal curvature. The goal is to relieve pain and improve quality of life.
For someone with AS, osteotomy might be an option if the spinal curvature is pronounced, such as in cases of severe kyphosis. The surgeon may cut and realign portions of the spinal bone so the spine is straighter.
Spinal fusion
During spinal fusion, the surgeon fuses two vertebrae together. They place a graft of bone between two vertebrae that helps them eventually grow together.
Spinal fusion is performed to help stabilize the spine and may be combined with other surgeries. This procedure can also be helpful when vertebrae movement is the source of pain.
Hip joint replacement
In a hip joint replacement, portions of the hip bone or joint are taken out and replaced with a prosthesis.
A doctor may recommend hip replacement when AS causes mobility limitations in the joints. The hip joint replacement may be a minimally invasive procedure.
Surgery is often the last line of treatment for AS. Most people with AS never need surgery. However, doctors may recommend surgery if one of the following apply:
- severe, persistent pain
- severe limitation of mobility
- reduction in quality of life
The type of surgery you may have will depend on how AS affects you. For example, a laminectomy may help relieve pain, or an osteotomy may help to straighten the spine. A hip replacement may improve hip joint mobility and reduce hip pain.
The cost of surgery for AS varies significantly between:
- hospitals
- geographic regions
- your specific medical needs
Your insurance company may cover all or part of the cost of the procedure.
The overall cost may depend on factors such as:
- the complexity and length of the procedure
- the length of the hospital stay
- any complications that arise
According to a 2022 study on the costs of lumbar fusion surgery for spondylolisthesis from 2010 to 2017, the mean cost was $30,827. The cost increased if people experienced complications following surgery. The mean cost for people who had serious complications was $51,980.
Spinal osteotomy surgeries to adjust the curvature of the spine can be more expensive, ranging from about $103,143 to $211,636, according to a 2020 review of research. Older age was associated with a more expensive procedure.
Your care team and insurance company can help you better understand your cost estimates before surgery for AS.
Recovery time, postsurgery, depends on the type of procedure you’ve had and your overall health.
Most people spend a few days to a week in the hospital immediately following spine surgery. Some will be up and walking with assistance on the same day.
Depending on the type of surgery, full recovery can take anywhere from a few weeks to a few months. During that time, your healthcare team will closely monitor your progression.
You may need physical therapy to regain mobility. Many people may need to wear a brace for several weeks. You’ll likely need follow-up X-rays to make sure the area is healing correctly.
It typically takes less time to recover from a minimally invasive procedure than open-spine surgery.
Learn about recovery from spinal fusion surgery.
Overall, surgery can have successful outcomes for people with AS who are in severe pain, are experiencing severely limited mobility, or have significantly reduced quality of life.
The rate of success for AS spine surgeries may vary depending on the severity of the condition and the person’s overall health.
As with any surgical procedure, it’s important to remember that there are also many potential risks to consider. They can include:
- infection
- dislocation
- fracture
- potential need for revision
- respiratory complications, such as pneumonia
Another factor that can affect the outcome is how closely the person sticks with their postsurgical care plan, including physical therapy and regular doctor visits to monitor any changes.
The outlook for people with AS who have surgery is generally good.
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However, not all procedures can be performed as minimally invasive surgeries.
Severe AS can be treated with surgery, including spinal surgeries and other types. Most people with AS do not need surgery.
Surgery for AS can be expensive but may be covered by insurance.
Recovery typically includes physical therapy and continued monitoring with X-rays.