Ankylosing Spondylitis Surgery: Types, Recovery & Treatment – GetWellGo

What is Ankylosing Spondylitis?

Ankylosing Spondylitis (AS) is a type of inflammatory arthritis that mostly affects the spinal region, while it can also include other joints and parts of the body such as hips, shoulder and peripheral joint. It leads to inflammation of the spinal bones referred to as vertebrae hence causes stiffness and pain in the back and neck area. The inflammation may be constant for several years, and this may cause the vertebrae involved to grow together thereby reducing their flexibility and leading to a bent posture.

Types of Ankylosing Spondylitis Surgery

These surgeries are done in special circumstances when the ankylosing spondylitis has caused much structural damage, deformity or loss of functionality, which cannot be controlled by medication or physiotherapy. There are numerous procedures that may be done for AS; however; the main ones are as follows:

Spinal Surgery:

• Spinal Fusion (Spondylodesis): It is a common surgery treatment method of Ankylosing Spondylitis. It refers to the process of joining two or more vertebra together so as to fix them in a certain position to minimize movement between them, a technique that is used when movement between joint and other structures cause pain. It is mainly done in the neck, middle of the back and lower back regions based on the affected areas.
• Osteotomy: Osteotomy may also be done if there is serious deformation such as forward stooping due to extensive kyphosis. This may include an operation that involves resection of the deformed or compressed portion of the vertebra and repositioning of the other ones.
• Corrective Surgery: Severe cases may require surgical intervention where deviations such as the hunchback position may be corrected by removing some section of the spine or by nucleation as well as fixing metal rods and screws to the backbone to align it properly.

Hip Replacement Surgery:

• It may result in spondylitis and arthritis specifically to joint of the hips. In extreme cases, the hip may freeze up and become painful and surgery might be required to replace the hip or hip joint (total hip arthroplasty).

Knee or Other Joint Replacement Surgery:

• For patients whose knees or shoulders are involved by AS surgical intervention such as joint replacement can be done with a view to relieving pain and improve the health of the joint involved.

Sacroiliac Joint Surgery:

• In some circumstances, if the bone joint that links the spine to the pelvic is in severe pain or damaged, then a surgical intervention to combine this joint is done.

Spinal Decompression:

• In some instances with AS, it leads to severe reduction in space for the spinal cord (spinal stenosis) to occupy; spinal decompression surgery is advisable. This includes excision or decompressive surgery wherever there is pressure being applied to the spinal cord or to the nerves, this may help to ease the pain and also improve functioning.

Spinal Stabilization Surgery:

• In severe circumstances, where the spine cannot support an individual or there is such malformation, stabilization surgery may be conducted. This process may require the application of metals such as rods, screws, and plates to strengthen the spine so that it does not cause more harm.

Ankylosing Spondylitis Treatment

There is no cure for ankylosing spondylitis but the treatment involves control of pain and inflammation, enhanced mobility and preventing complications such as deformity of the spine. The main indicated therapy includes medication, physical therapy, and change of life regimen. Here are the main approaches:

Medications

• Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
• Tumor Necrosis Factor (TNF) Inhibitors
• Interleukin-17 (IL-17) Inhibitors
• Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
• Corticosteroids
• Analgesics

Physical Therapy

• Exercise
• Stretching
• Postural Training

Lifestyle Changes

• Regular Exercise
• Good Posture
• Weight Management
• Smoking Cessation

Surgical Treatment

• Heat and Cold Therapy
• Complementary Therapies
• Psychological Support
• Monitoring and Ongoing Care
• Management of Eye Inflammation

Factors Affecting Ankylosing Spondylitis Surgery Cost in India

The cost of Ankylosing Spondylitis (AS) surgery in India differs from one hospital to the other as it depends on different factors as discussed below.

Here’s a detailed breakdown:

• Type of Surgery
• Hospital and Location
• Surgeon's Expertise
• Extent of Surgery Required
• Pre-Surgical Workup
• Implants and Devices
• Hospital Stay and ICU Requirement
• Post-Surgical Rehabilitation
• Medical Insurance

Ankylosing Spondylitis Recovery

In case of such surgeries as spinal correction or hip replacement, more definite rehabilitation regime will be set:

Immediate Post-Surgery Phase (0–6 weeks):

• Hospital stay too depends on the type of surgery ranging it between 5-10 days on average.
• Pain management with medications.
• Gentle movements with assistance (physiotherapist-guided).
• Wound care and infection prevention.

Rehabilitation Phase (6 weeks–6 months):

• Physical therapy entails involving the patient in a simple dance, stretching to the most rigorous movements.
• They may use a walking aid such as a walker, crutches depending on the degree of disability after the joint replacements.
• Patients who undergo spinal surgery not only need to learn a normal gait, but also should re-train the muscles so that they could easily maintain a right posture.

Long-Term Recovery (6 months and beyond):

• The majority of patients achieve the loss of pain and improvement of movements within half a year after the intervention.
• Assuming that one starts with a clean muscle, it may take 6–12 months for the bulk and balance at the peak.
• Therefore, performing exercises, physiotherapy and observing good body posture are life-long requirements.

Ankylosing Spondylitis Diagnosis

Medical History

• Symptoms: The physician inquires about chronic pain in the back (particularly pain that gets better with exercise and gets worse with rest), stiffness in the mornings, tiredness, and joint pain.
• Duration: More than 3 months of back pain is an important sign.
• Age of Onset: Symptoms begin typically between 15–40 years of age.
• Family History: A family history of AS or other autoimmune disorders makes it suspicious.

Physical Examination

• Spinal Flexibility Tests: The physician examines how supple the spine is (e.g., forward bending, side bending).
• Chest Expansion Test: Decreased chest expansion is typical as a result of stiffness of the rib joints.
• Posture Check: Early kyphosis (forward bending of the spine) might be observed.
• Tenderness: Applying pressure over the sacroiliac joints (lower back, where the pelvis joins the spine) can be painful.

Imaging Tests

X-rays:

• Can demonstrate alterations in the sacroiliac joints and spine, such as joint space narrowing, bone erosion, or fusion.
• Changes in early stages might not appear prominently, hence X-rays are of more use in advanced stages.

MRI (Magnetic Resonance Imaging):

• Much more sensitive than X-rays.
• Is able to identify early inflammation of the sacroiliac joints and spine before structural changes occur.
• MRI assists in the early diagnosis of AS and initiation of treatment.

CT Scan:

• Occasionally used if X-rays and MRI are not conclusive, particularly to visualize bone detail within sacroiliac joints.

Laboratory Tests

• HLA-B27 Genetic Test:
• 80–90% of individuals with AS carry the HLA-B27 gene.
• Having HLA-B27, however, does not always mean a person will develop AS (some healthy individuals also carry it).

Blood Tests:

• Inflammatory markers such as ESR (Erythrocyte Sedimentation Rate) and CRP (C-reactive protein) are usually increased during active illness.
• These markers indicate the presence of inflammation but are not AS-specific.
• Other infection, rheumatoid arthritis, or other causes of back pain should be ruled out by other tests.

Diagnostic Criteria

• Physicians usually apply formal criteria, such as the Modified New York Criteria or ASAS (Assessment of SpondyloArthritis International Society) criteria, which incorporate symptoms, imaging, and blood results to formally diagnose AS.

Top Hospitals for Ankylosing Spondylitis Surgery

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Max Hospital, Saket
• Apollo Hospital, Delhi

Best Doctors for Ankylosing Spondylitis Surgery

• Dr. Hitesh Garg
• Dr. Rajiva Gupta
• Dr. SKS Marya
• Dr. Rohini Handa

Ankylosing Spondylitis Procedure

Surgery is uncommon but may be required when AS leads to severe deformities or joint destruction:

Spinal Osteotomy:

• Surgical operation to cut and realign sections of the spine if there's extreme forward bending (kyphosis).
• It straightens posture and enhances the capacity to stand upright.

Spinal Fusion Surgery:

• Fusion of unstable or damaged spinal segments to alleviate pain and prevent further deformity.

Joint Replacement (Arthroplasty):

• Most frequently hip replacements since AS tends to affect hips.
• Sometimes replacement of knees if the other joints are severely affected.

Sacroiliac Joint Fusion:

• Operative fusion of sacroiliac joints if the sacroiliac joints are severely painful and damaged.

Ankylosing Spondylitis Recovery Time

Typical recovery time:

• Hospital stay: 5–10 days after surgery.
• Initial recovery: 6–12 weeks (walking with support, basic activities).
• Full recovery: 6–12 months to regain strength, flexibility, and good posture.

Ankylosing Spondylitis Risks

• Spinal Fusion
• Spinal Fractures
• Severe Posture Problems
• Hip and Shoulder Damage
• Osteoporosis
• Heart Disease
• Lung Problems
• Uveitis (Iritis)
• Inflammatory Bowel Disease (IBD)
• Depression and Anxiety

Ankylosing Spondylitis Success Rate

Medical treatment

70–80% symptom improvement

Biologic therapies

60–75% achieve low disease activity

Hip replacement surgery

90%+ pain relief and mobility restored

Spinal corrective surgery

80–85% improvement in posture and function

Overall quality of life (with treatment)

80%+ can live active lives