Surgery for Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2022 | Last updated: June 2022

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:1

  • Maximize quality of life
  • Prevent or slow progressive structural damage
  • Control symptoms and inflammation
  • Preserve mobility

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

Who gets surgery for AxSpA spectrum conditions?

In some people with AxSpA spectrum conditions, hip or spine surgery may be beneficial. Surgery may be used for: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 a more rigid cervical spine. Your doctor will discuss the risks and benefits with you so you can make an informed decision about your treatment.2

Total hip arthroplasty for AxSpA spectrum conditions

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

Spinal surgery for AxSpA spectrum conditions

Surgery is recommended in people who have an acute fracture. This most commonly occurs in the cervical spine in AxSpA spectrum conditions.2Cervical fusion is one of the spinal surgeries done. This is a fusion of the bones in the upper (cervical) spine. It is often recommended for a fracture or dislocation of these bones. This impairs flexion and can damage the spinal cord. By fusing these bones, surgery prevents this from happening again.2Wedge 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 realigned and then braced so it can heal. This surgery may be used for those who have major deformities of the neck and back. It is also recommended for those who have curvature of the spine that causes hunching over (kyphosis).3

Things to think about

With any surgery, there are risks and benefits, as well as possible complications. There may be:4

  • Anesthesia complications
  • Risks of blood clots
  • Lung issues
  • Infections
  • Lingering or persistent pain
  • Injury to the spinal cord

There is also recovery time to think about. Talk with your doctor about the surgery and what to expect. They can also address what surgery might do for your symptoms and any questions or concerns you may have.

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