Archive \ Volume.12 2021 Issue 2

An Overview on the Role of Surgical Management in Ankylosing Spondylitis

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Ankylosing spondylitis is a chronic illness affecting the spine/pelvic limb joints and the sacroiliac, resulting in ankylosis and deformity of joints and the spine. Hip joints can be affected on both sides, making them more susceptible and prone to more significant injury than other joints. Even though novel biological therapies have drastically altered the management of this illness, surgical intervention is still necessary in some cases. To evaluate the role of surgical treatment in ankylosing spondylitis and provide a good review of the different surgical options suggested for different situations. For articles selection, the PubMed database was utilized, and the following keys were used in the Mesh ((“ankylosing spondylitis” [Mesh]) AND (“surgical management”[Mesh]) OR (“evaluation” [Mesh])). Patients with ankylosing spondylitis are commonly susceptible to developing severe structural and functional complications to the hip and the spine, such as severe kyphosis, severe hip arthritis, heterotopic ossification, and a spinal fracture. In such cases, surgical intervention is mostly needed. However, there are a lot of controversies surrounding surgical intervention in different situations of ankylosing spondylitis.

How to cite:
Alahmari ASA, Qari SK, Asiri RI, Almohammadi TA, Alqarni MAM, Aljahdali HM, et al. An Overview on the Role of Surgical Management in Ankylosing Spondylitis. Arch Pharm Pract. 2021;12(2):106-11.
Alahmari, A. S. A., Qari, S. K., Asiri, R. I., Almohammadi, T. A., Alqarni, M. A. M., Aljahdali, H. M., Alnasser, A. H., Alaqeel, F. A., Kazim, O. A., Qasem, H. A. O., et al. (2021). An Overview on the Role of Surgical Management in Ankylosing Spondylitis. Archives of Pharmacy Practice, 12(2), 106-111.

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1.        van Royen BJ, Dijkmans BA, editors. Ankylosing spondylitis: diagnosis and management. CRC Press; 2006. doi:10.3109/9780849374463

2.        Alenazi SM, Aljahdali AF, Alwakil AI, Alghafari MA, Alshahrani AA, Almansouri FA, et al. An overview of abdominoplasty surgical approach: a literature review. Pharmacophore. 2020;11(6):48-51.

3.        Moon KH, Kim YT. Medical treatment of ankylosing spondylitis. Hip Pelvis. 2014;26(3):129-35. doi:10.5371/hp.2014.26.3.129

4.        Zochling J, Maxwell L, Beardmore J, Boonen A. Tnf-Alpha Inhibitors for Ankylosing Spondylitis. Cochrane Database Syst Rev. 2005. doi:10.1002/14651858.cd005468

5.        Khan MA. Update on spondyloarthropathies. Ann Intern Med. 2002;136(12):896-907. doi:10.7326/0003-4819-136-12-200206180-00011

6.        Garcia-Montoya L, Gul H, Emery P. Recent advances in ankylosing spondylitis: understanding the disease and management. F1000Res. 2018;7:1512. doi:10.12688/f1000research.14956.1

7.        Chen B, Li J, He C, Li D, Tong W, Zou Y, et al. Role of HLA-B27 in the pathogenesis of ankylosing spondylitis. Mol Med Rep. 2017;15(4):1943-51. doi:10.3892/mmr.2017.6248

8.        McVeigh CM, Cairns AP. Diagnosis and management of ankylosing spondylitis. BMJ. 2006;333(7568):581-5. doi:10.1136/

9.        Linden SV, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. Arthritis Rheum. 1984;27(4):361-8. doi:10.1002/art.1780270401

10.      Moll JM, Wright V. New York clinical criteria for ankylosing spondylitis. A statistical evaluation. Ann Rheum Dis. 1973;32(4):354-63. doi:10.1136/ard.32.4.354

11.      Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria?. Arthritis Rheum. 2005;52(4):1000-8. doi:10.1002/art.20990

12.      Braun J, Landewé R, Hermann KG, Han J, Yan S, Williamson P, et al. Major reduction in spinal inflammation in patients with ankylosing spondylitis after treatment with infliximab: results of a multicenter, randomized, double‐blind, placebo‐controlled magnetic resonance imaging study. Arthritis Rheum: Off J Am Coll Rheumatol. 2006;54(5):1646-52. doi:10.1002/art.21790

13.      Baraliakos X, Brandt J, Listing J, Haibel H, Sörensen H, Rudwaleit M, et al. Outcome of patients with active ankylosing spondylitis after two years of therapy with etanercept: clinical and magnetic resonance imaging data. Arthritis Care Res: Off J Am Coll Rheumatol. 2005;53(6):856-63. doi:10.1002/art.21588

14.      Cairns AP, Wright SA, Taggart AJ, Coward SM, Wright GD. An open study of pulse pamidronate treatment in severe ankylosing spondylitis, and its effect on biochemical markers of bone turnover. Ann Rheum Dis. 2005;64(2):338-9. doi:10.1136/ard.2004.022871

15.      van den Berg R, Baraliakos X, Braun J, van der Heijde D. First update of the current evidence for the management of ankylosing spondylitis with non-pharmacological treatment and non-biologic drugs: a systematic literature review for the ASAS/EULAR management recommendations in ankylosing spondylitis. Rheumatology. 2012;51(8):1388-96. doi:10.1093/rheumatology/kes066

16.      Dagfinrud H, Hagen KB, Kvien TK. Physiotherapy interventions for ankylosing spondylitis. Cochrane Database Syst Rev. 2008;2008(1):CD002822. doi:10.1002/14651858.cd002822.pub3

17.      Lubrano E, Astorri D, Taddeo M, Salzmann A, Cesarano E, Brunese L, et al. Rehabilitation and surgical management of ankylosing spondylitis. Musculoskelet Surg. 2013;97(2):191-5. doi:10.1007/s12306-013-0285-9

18.      Cooksey R, Brophy S, Husain MJ, Irvine E, Davies H, Siebert S. The information needs of people living with ankylosing spondylitis: a questionnaire survey. BMC Musculoskelet Disord. 2012;13(1):1-8. doi:10.1186/1471-2474-13-243

19.      Vander Cruyssen B, Muñoz-Gomariz E, Font P, Mulero J, De Vlam K, Boonen A, et al. Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology. 2010;49(1):73-81. doi:10.1093/rheumatology/kep174

20.      Braun JV, Van Den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2011;70(6):896-904. doi:10.1136/ard.2011.151027

21.      Batra YK, Sharma A, Rajeev S. Total spinal anaesthesia following epidural test dose in an ankylosing spondylitic patient with anticipated difficult airway undergoing total hip replacement. Eur J Anaesthesiol. 2006;23(10):897-8. doi:10.1017/s0265021506251378

22.      Valle-Onate R, Ward MM, Kerr GS, Deodhar A, Clegg D. Physical therapy and surgery. Am J Med Sci. 2012;343(5):353-6. doi:10.1097/maj.0b013e3182514080

23.      Tang WM, Chiu KY. Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty. 2000;15(1):52-8. doi:10.1016/s0883-5403(00)91155-0

24.      Schwarzkopf R, Cohn RM, Skoda EC, Walsh M, Jaffe F. The predictive power of preoperative hip range of motion for the development of heterotopic ossification. Orthopedics. 2011;34(3):169. doi:10.3928/01477447-20110124-10

25.      Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine. 2010;35(11):E458-64. doi:10.1097/brs.0b013e3181cc764f

26.      Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X, et al. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res. 2019;7(1):1-6. doi:10.1038/s41413-019-0057-8

27.      Kubiak EN, Moskovich R, Errico TJ, Di Cesare PE. Orthopaedic management of ankylosing spondylitis. J Am Acad Orthop Surg. 2005;13(4):267-78. doi:10.5435/00124635-200507000-00006

28.      Qian BP, Mao SH, Jiang J, Wang B, Qiu Y. Mechanisms, predisposing factors, and prognosis of intraoperative vertebral subluxation during pedicle subtraction osteotomy in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis. Spine. 2017;42(16):E983-90. doi:10.1097/brs.0000000000002015

29.      He A, Xie D, Cai X, Qu B, Kong Q, Xu C, et al. One-stage surgical treatment of cervical spine fracture-dislocation in patients with ankylosing spondylitis via the combined anterior–posterior approach. Medicine. 2017;96(27). doi:10.1097/md.0000000000007432

30.      Lin B, Zhang B, Li ZM, Li QS. Corrective surgery for deformity of the upper cervical spine due to ankylosing spondylitis. Indian J Orthop. 2014;48(2):211-5. doi:10.4103/0019-5413.128771

31.      Koller H, Koller J, Mayer M, Hempfing A, Hitzl W. Osteotomies in ankylosing spondylitis: where, how many, and how much?. Eur Spine J. 2018;27(1):70-100. doi:10.1007/s00586-017-5421-z

32.      Bourghli A, Boissière L, Vital JM, Bourghli MA, Almusrea K, Khoury G, et al. Modified closing-opening wedge osteotomy for the treatment of sagittal malalignment in thoracolumbar fractures malunion. Spine J. 2015;15(12):2574-82. doi:10.1016/j.spinee.2015.08.062

33.      Weiss RJ, Wick MC, Ackermann PW, Montgomery SM. Increased fracture risk in patients with rheumatic disorders and other inflammatory diseases—a case-control study with 53,108 patients with fracture. J Rheumatol. 2010;37(11):2247-50. doi:10.3899/jrheum.100363

34.      Westerveld L, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 2009;18(2):145-56. doi:10.1007/s00586-008-0764-0

35.      Kurucan E, Bernstein DN, Mesfin A. Surgical management of spinal fractures in ankylosing spondylitis. J Spine Surg. 2018;4(3):501-8. doi:10.21037/jss.2018.06.15

36.      El Tecle NE, Abode-Iyamah KO, Hitchon PW, Dahdaleh NS. Management of spinal fractures in patients with ankylosing spondylitis. Clin Neurol Neurosurg. 2015;139:177-82. doi:10.1016/j.clineuro.2015.10.014

37.      Ramos-Remus C, Gomez-Vargas A, Hernandez-Chavez A, Gamez-Nava JI, Gonzalez-Lopez L, Russell AS. Two-year follow-up of anterior and vertical atlantoaxial subluxation in ankylosing spondylitis. J Rheumatol. 1997;24(3):507-10.

38.      Hunter T. The spinal complications of ankylosing spondylitis. InSeminars in Arthritis Rheum. 1989;19(3):172-82. doi:10.1016/0049-0172(89)90030-9

39.      Harrop JS, Sharan A, Anderson G, Hillibrand AS, Albert TJ, Flanders A, et al. Failure of standard imaging to detect a cervical fracture in a patient with ankylosing spondylitis. Spine. 2005;30(14):E417-9. doi:10.1097/01.brs.0000170594.45021.67

40.      Lu ML, Tsai TT, Lai PL, Fu TS, Niu CC, Chen LH, et al. A retrospective study of treating thoracolumbar spine fractures in ankylosing spondylitis. Eur J Orthop Surg Traumatol. 2014;24(1):117-23. doi:10.1007/s00590-013-1375-y

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