Ankylosing spondylitis (AS) is an autoimmune condition that generally affects the central skeleton, including the rib cage, spine, and pelvis. Damage to the spine can be especially problematic because it is a supporting structure for the entire body, and degeneration can eventually damage critical nerves. There are surgical interventions for severe damage associated with AS.
The chronic inflammatory processes associated with AS can cause weakening of the vertebrae and their attachments, causing the spine to become unstable. Depending on the extent of damage, bracing may be appropriate until an exact surgical approach is determined. Usually, when the spine is fused, metal supports are anchored to areas of the spine that are unaffected by AS, and pins may be used to attach the damaged areas to the supports. This added support may also prevent vertebrae from collapsing onto the spinal cord or nerves leaving the spine, thereby reducing the chances of severe nerve damage and ongoing pain. Since the areas treated by fusion will have no range of motion, people who have spinal fusion may need significant physical rehabilitation to adjust to performing routine tasks with limited spinal motion.
Reducing compression on the spinal cord and other nerves can reduce the risk of paralysis and potentially ease some types of pain associated with AS. For example, pressure on nerves leading to the arms or legs could cause severe, radiating pain that travels down the extremities. A laminectomy is a form of spinal decompression surgery which can be used to eliminate pressure on the spinal cord or nerve roots caused by degeneration of the vertebrae. Usually a portion of the lamina, which is located at the back of the vertebra, is removed, which gives the spinal cord more room and reduces pressure.
If the procedure is performed on a few vertebrae, it might be performed using minimally invasive techniques, which can significantly reduce the time for recovery. If the goal is to decompress the spine, other procedures might be used depending on which area of the spine is affecting the nerves. For example, the large opening containing the spinal cord (foramen) might be surgically enlarged if damage has occurred and the opening is beginning to encroach on the spinal cord. In some instances, simply removing fragments of bone might aid in spinal decompression.
Since the process of AS not only causes damage to the skeleton but also may eventually cause a fusion of bones, sometimes it is necessary to correct deformities through an osteotomy. Spinal deformities can be corrected by removing segments of the vertebrae in an attempt to replicate the natural curvature of the spine. Depending on the extent of the deformity, only a small amount of bone may need to removed, and bone grafting may not be required to achieve the desired result. In the case of substantial deformities, several vertebrae may need to be removed, with metal supports used to substitute the missing vertebrae. Additionally, the area would be fused so the corrected area can be held into place.
When spinal deformities require significant surgical correction, the goal of having a completely normal spine may be unrealistic. However, some amount of correction may help with standing, walking, and performing routine activities, which can help a person maintain or regain independence. Additionally, small amounts of correction may have overall benefits for the biomechanics of the musculoskeletal system, reducing the possibility and severity of hip, knee, and foot problems.
Many instances of AS are managed with a combination of pain management and medications to reduce disease progression. For some people, AS can cause severe damage that requires surgical intervention to reduce pain or correct the spine. To learn more about treatment options, contact a medical facility like Healthpointe.