Cervical Osteotomy in Ankylosing Spondylitis

Abstract

Ankylosing spondylitis (AS) is an inflammatory disease in which joints become arthritic and eroded, followed by autofusion (ankylosis). AS typically affects the axial spine with the initial onset of sacroiliitis, followed by involvement of the lumbar spine with progression cranially to involve the rest of the spinal column. A thoracolumbar kyphosis is the most common deformity which causes hard standing, walking, looking horizontally, and so on. Although thoracolumbar kyphotic deformities are most common, the cervical and/or upper thoracic spine can also be involved. If the primary deformity has been determined to be in the cervical spine, the patient is unable to see straight ahead. Patients with these deformities, in addition to the problems with horizontal gaze, also can experience other debilitating symptoms, including limitation of chewing, speaking, or swallowing. The only available treatment is an osteotomy at the cervicothoracic junction. The chin-brow angle is of paramount importance when planning a corrective osteotomy in the cervicothoracic region [1]. Surgery aims to restore horizontal gaze and sagittal balance, improve function, diminish social disability, and provide durable correction. A key point is not to overcorrect the horizontal gaze because this can lead to inability of patients to see the floor ahead of them [2–4].