I am a 32-year old man with ankylosing spondylitis (AS). I've had it since I was 19. Despite medical treatment and ongoing physical therapy, I'm still losing spinal motion. I'm starting to get bent over and can no longer straighten up. When do people with this condition start looking into surgical options?

Surgery is considered when all other options have failed to stop the progression of the disease. Morning stiffness, back pain, and loss of function begin to impair daily activities. Loss of chest expansion and spinal deformity can affect breathing leading to chronic respiratory problems.

Anyone with AS who has severe deformity that interferes with vision, breathing, walking, or digestion should consider surgery. Anyone with spinal instability would also qualify. Correction of deformities and/or spinal fusion may be helpful.

There's one other nonsurgical treatment that may be advised first. The new TNF inhibitor drugs can offer improvements in your symptoms and even arrest or stop the disease process from getting worse. Long-term studies aren't available but short-term results are very promising. Ask your doctor if you might be a good candidate to try a three or four month trial of these drugs.

David Borenstein, MD, FACR, FACP. Inflammatory Arthritides of the Spine. In Clinical Orthopaedics and Related Research. February 2006. No. 443. Pp. 208-221.

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