Most people with AS won't need surgery
New medical treatments and knowledge about how exercise can benefit people with AS has reduced the need for surgery.
For those who do need it, surgery can make a huge difference to your quality of life by reducing pain and improving mobility.
The two types of surgical treatment that are sometimes needed by people with AS are:
- Joint replacement surgery
- Spinal corrective surgery
If you're thinking of having surgery you'll want to give careful consideration to the benefits and risks.
Deciding whether to have surgery
The decision to have surgery will be made by you with advice from your consultant. Find out as much as you can so that you have all the information you need to make your decision.
You need to get a clear picture from your consultant about how much they expect you will be able to do once you have recovered from surgery.
You may want to ask your surgeon about their levels of experience and success rates for the operation. If you are having a more specific procedure, like an operation on your hand or ankle, make sure it is performed by a surgeon who specialises in that area.
It is also important that you discuss anaesthesia well in advance of the proposed surgery. Many people with AS will have no problems with anaesthesia but there are some for whom problems may arise and it's important to be aware of this in advance of any planned surgery.
Click to read more about anaesthesia and AS.
You will also need to think about how you will manage after the operation. It is likely that you will need some support from family, friends or a carer, which you should organise beforehand.
The result of surgery for AS can be less pain and more mobility. The benefits of this include:
- Being able to do more exercise
- Improved mental and emotional well-being
- You may get a boost to your self-confidence
- You may feel less tense and irritable
- You may be able to lead a more active social life
- You may feel less dependent on your family and others
All surgery carries risks. It's important you ask your surgeon about the risks of your particular procedure. They should give you enough information so you feel able to make an informed choice about having surgery.
Ask your consultant what degree of movement and function they realistically expect you to have after your operation.
Bear in mind there is still a risk that your operation may not be as successful as you had hoped.
Joint replacement surgery
Some people may need surgery to replace a joint that has become severely damaged as a result of AS.
The medical term for joint replacement surgery is arthroplasty. The most common types of joint replacement surgery are hip and knee replacement. Other, less common, types of joint replacement include ankle, shoulder and elbow replacement.
Joint replacement should help to:
- Relieve pain
- Improve mobility
Some people with AS can develop curvature of the spine (kyphosis) which is so severe that they can no longer look straight forward comfortably or look people in the eye. In addition to practical difficulties such as eating and drinking this can lead to social isolation, neck pain and unsteadiness.
If you have severe curvature of the spine we recommend that you discuss the possibility of spinal surgery with your rheumatology consultant. If your consultant does feel surgery might benefit you, then you should be referred on to a team specialising in spinal surgery.
Surgery will be considered if :
- Your spine is unstable, meaning that it has fractured
- Your spine is very deformed making it difficult to carry out activities of daily living such as eating or drinking
- The deformity in your spine is leading to nerve damage
This type of surgery is now far more successful than in the past. There is a better understanding of how to prevent damage to the spinal cord and less invasive methods are now used.
Spinal osteotomy will not give you back your normal function if your spine is fused. This type of surgery fuses your spine in a straighter position which allows your head to face forwards rather than looking down towards the floor. Parts of the spine can be stabilised with rods and screws and fragments of bone can be removed in order to adjust the posture and correct bending in the neck or back. Surgery cannot simply chip off the fused bits leaving an un-fused and fully mobile spine.
Spinal surgery is generally considered to be high risk. The higher up the spine the surgery needs to take place the greater the potential risk. You should make sure you discuss all the potential risks and benefits in depth with a specialist spinal surgeon. If you feel unsure seek a second opinion.