Comprehensive Management of Ankylosing Spondylitis: Pharmacotherapeutic Approaches and Surgical Correction of Kyphotic Deformity
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Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton, often leading to significant functional impairment and spinal deformities. This case report highlights the diagnostic challenges and the necessity of a multidisciplinary management approach for advanced AS. To evaluate the effectiveness of a comprehensive treatment approach combining pharmacological and surgical interventions in improving clinical outcomes and quality of life in patients with severe ankylosing spondylitis (AS) and thoracolumbar kyphotic deformity (TLKD), a 26-year-old male presented with a four-year history of worsening inflammatory back pain that improved with activity but worsened at rest. Radiographic imaging revealed characteristic “bamboo spine” and “dagger spine” appearances, while laboratory tests showed elevated inflammatory markers (CRP and ESR). The patient was diagnosed with radiographic ankylosing spondylitis with very high disease activity (ASDAS-CRP 3.98) and a severe thoracolumbar kyphotic deformity (TLKD). The patient received a comprehensive treatment regimen consisting of meloxicam (7.5 mg twice daily) and the TNF-? inhibitor etanercept (50 mg weekly) to control systemic inflammation. To address the structural deformity, the orthopedic team performed a pedicle subtraction osteotomy (PSO). At the four-month follow-up, the patient demonstrated significant clinical improvement. The ASDAS-CRP score decreased from 3.98 to 2.9, indicating reduced disease activity. Surgical correction resulted in a substantial improvement in the chin-brow-to-vertical angle (CBVA) from 31.1° to 20.2°, restoring the patient’s horizontal gaze and improving overall postural balance and quality of life.
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