Ankylosing spondylitis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S[2]

Overview

Surgery is not the first-line treatment option for patients with ankylosing spondylitis.Surgical options, such as knee and hip replacements, can be an option for patients with ankylosing spondylitis. Surgical correction is also possible for those with severe flexion deformities, such as a severe downward curvature of the spine.

Surgery

  • Surgery is not the first-line treatment option for patients with ankylosing spondylitis. Surgery is usually reserved for selected patients with ankylosing spondylitis.
Total hip arthroplasty(THA)[1][2]
  • Hip involvement is seen more common in ankylosing spondylitis patients with early onset of disease.
  • Total hip arthroplasty(THA) surgery is usually reserved for patients with either:[3][4]
    • Severe and persistent pain that does not respond to drugs.
    • Severe limitation in mobility of affected joint.
    • Decreased quality of life due to hip involvement.
  • THA at a mean age of 40 years shows excellent long-term results.[5]

Spinal surgery[6] 

  • Patients who are having flexion deformities that are severe enough to impair daily activities can undergo Wedge osteotomy.[7]
  • Spinal surgeon consultation is indicated in the following
    • In the event of vertebral fractures.
    • Unusual neck or back pain.

References

  1. Vander Cruyssen B, Muñoz-Gomariz E, Font P, Mulero J, de Vlam K, Boonen A, Vazquez-Mellado J, Flores D, Vastesaeger N, Collantes E (January 2010). "Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery". Rheumatology (Oxford). 49 (1): 73–81. PMID 19605374. doi:10.1093/rheumatology/kep174. 
  2. Chen HA, Chen CH, Liao HT, Lin YJ, Chen PC, Chen WS, Chou CT (June 2011). "Factors associated with radiographic spinal involvement and hip involvement in ankylosing spondylitis". Semin. Arthritis Rheum. 40 (6): 552–8. PMID 20870274. doi:10.1016/j.semarthrit.2010.07.008. 
  3. Vander Cruyssen B, Muñoz-Gomariz E, Font P, Mulero J, de Vlam K, Boonen A, Vazquez-Mellado J, Flores D, Vastesaeger N, Collantes E (January 2010). "Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery". Rheumatology (Oxford). 49 (1): 73–81. PMID 19605374. doi:10.1093/rheumatology/kep174. 
  4. Joshi AB, Markovic L, Hardinge K, Murphy JC (June 2002). "Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips". J Arthroplasty. 17 (4): 427–33. PMID 12066271. 
  5. Sweeney S, Gupta R, Taylor G, Calin A (August 2001). "Total hip arthroplasty in ankylosing spondylitis: outcome in 340 patients". J. Rheumatol. 28 (8): 1862–6. PMID 11508591. 
  6. Ravinsky RA, Ouellet JA, Brodt ED, Dettori JR (April 2013). "Vertebral Osteotomies in Ankylosing Spondylitis-Comparison of Outcomes Following Closing Wedge Osteotomy versus Opening Wedge Osteotomy: A Systematic Review". Evid Based Spine Care J. 4 (1): 18–29. PMC 3699248Freely accessible. PMID 24436696. doi:10.1055/s-0033-1341604. 
  7. Kim KT, Park DH, Lee SH, Lee JH (September 2015). "Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity". Clin Orthop Surg. 7 (3): 330–6. PMC 4553281Freely accessible. PMID 26330955. doi:10.4055/cios.2015.7.3.330. 

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