Case Study and Clinical Highlight: Perioperative Considerations in Ankylosing Spondylitis

A 73-year-old man with history of ankylosing spondylitis (AS) presents to your office for a follow-up visit and medication management. His treatment plan consists of celecoxib and adalimumab,  as well as a supervised home exercise program for postural training and range of motion stretching.  He reports persistent low back and neck pain, with slight improvement in the pain since starting medication. On physical examination, he has marked hyperkyphosis restricting chest excursion, sacroiliac joint tenderness, limited external rotation of the hips bilaterally, and dactylitis. His Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores have routinely been above 7.

He is scheduled to undergo elective surgery to repair a large ventral hernia, and he would like information about any risks surgical intervention may pose due to his advanced AS.  You are asked to discuss with him the specific perioperative considerations given to a patient with AS presenting for surgery.