Surgery for Axial Spondyloarthritis

There are a variety of treatments for AxSpA spectrum conditions. While these are chronic, progressive conditions with no cure, treatments are available. The goals of treatment are to maximize quality of life, prevent or slow progressive structural damage, and control symptoms and inflammation and preserve mobility.1

Surgery can be helpful for some patients, especially as the condition progresses or if other treatments have not been effective. Surgery is not used as a first-line treatment, and if you’re thinking about whether surgery is an appropriate treatment for your AxSpA spectrum condition, talk with your doctor about what symptoms you’re having, how it’s affecting your life, and what your options are. They will be able to tell you the risks and benefits of surgery, and whether it’s appropriate for you right now.

Who gets surgery for AxSpA spectrum conditions?

In some patients with AxSpA spectrum conditions, hip or spine surgery may be beneficial. Indications for surgery can include:2

  • Severe level of hip involvement, with pain or significant impairment of mobility and quality of life
  • Misalignment of the 1st and 2nd vertebrae, even if it only occurs with neck flexion
    Severe flexion deformities or impairment and impaired ability to look straight ahead

As with any treatment, surgery has its own risks, including reduced chest expansion and more rigid cervical spine.2 Your doctor will discuss the risks and benefits with you in order for you to make an informed decision about your treatment.

Total hip arthroplasty for AxSpA spectrum conditions

A total hip arthroplasty (THA), also known as a hip replacement, is typically recommended when there is persistent and severe pain in the hips, along with impaired mobility and quality of life.2 This is more commonly seen in those whose AxSpA spectrum condition had an earlier onset and axial and entheseal involvement.2 This surgery provides pain relief in approximately 90 percent of people who have it, as well as provides improved range of motion.2

Spinal surgery for AxSpA spectrum conditions

If there is acute fracture – most commonly, this occurs in the cervical spine in AxSpA spectrum conditions – surgery is recommended.2

Cervical fusion is one of the spinal surgeries done. This is fusion of the bones in the upper, or cervical spine. It is often recommended for a fracture or a dislocation of these bones.2 If this happens, it impairs flexion and can damage the spinal cord. By fusing these bones, it prevents this from happening again.

Wedge osteotomy is another type of spinal surgery that may be recommended. This surgery involves removing a wedge-shaped piece of bone from a vertebra. The spine is then realigned and then braced, in order for it to heal.3 This surgery may be appropriate for those who have significant deformities of the neck and back.3 It is also recommended for those who have kyphosis, or curvature of the spine that causes hunching over.3

Things to think about

With any surgery, there are risks and benefits, as well as possible complications. There may be anesthesia complications, risks of blood clots, lung issues, infections, lingering or persistent pain, or injury to the spinal cord.4 There is also recovery time to think about. Talk with your doctor about the surgery, what to expect, what it might do for your symptoms, and any questions or concerns you might have.

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Written by: Jaime Rochelle Herndon | Last reviewed: November 2020