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Last updated:24th October 2017

Surgery for AS

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 surgery 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 should 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.

 Get a clear picture from your consultant of how much they expect you will benefit from surgery and understand the risks.

 Ask your surgeon about their level 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.

 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.

 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.

  Bear in mind the risk that your operation may not be as successful as you had hoped. 

Anaesthesia

Types of anaethesia include:
Local anaesthetic - used for minor procedures to numb the nerves in
the area where the procedure is taking place. 
Regional anaesthetic – includes spinal block and epidural. Both are injected into your bac
General anaesthetic - used for more extensive surgery when you need to be
unconscious. 
Sedation - makes you feel sleepy and relaxes you both physically and mentally.
 

 Some people with AS can have problems with anaesthesia and it's important to be aware of this in advance of planned surgery.

General anaesthetic

With a general anaesthetic, the anaesthetist needs to pass a flexible tube down through your windpipe to help with breathing control and protect the lungs from inhaling the
stomach contents. It is called endotracheal intubation.
 
If you have a lot of neck involvement with your AS it can be very difficult for an anesthetist to safely insert the tube. This isn't an issue as long as the anesthetist is aware of the situation in advance of your surgery. There are lots of different options including using a fibre optic laryngoscope.
 
Epidural / spinal anaesthetic
 
Where you have changes to your spine due to new bone formation epidural or spinal anaesthesia may not be possible due to bony obstruction preventing the needle reaching either the spinal or epidural space. Again, we'd really recommend ensuring you discuss this in advance of surgery as an x-ray or MRI can be carried out to assess the situation and formulate a plan.
 

 Make sure you have an anaesthetic assessment in advance of surgery
 Download NASS Members experiences of anesthesia

 

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

Spinal Surgery

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.

 


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