Smh. Mehdian et al., Cervical osteotomy for ankylosing spondylitis: an innovative variation on an existing technique, EUR SPINE J, 8(6), 1999, pp. 505-509
Ankylosing spondylitis can produce severe fixed flexion deformity in the ce
rvical spine. This deformity may be so disabling that it interferes with fo
rward vision, chewing, swallowing and skin care under the chin. The only tr
eatment available is an extension osteotomy of the cervical spine. Existing
techniques of cervical osteotomy may be associated with risk of neurologic
al injury. We describe a variation on an existing technique, which provides
a controlled method of reduction at the osteotomy site, eliminating sagitt
al translation. The method employs a modular posterior cervical system cons
isting of lateral mass and thoracic pedicle screws linked to titanium rods.
Our technique substitutes the titanium rod with a temporary malleable rod
on one side, allowing controlled reduction of the osteotomy as this rod ben
ds and slides through the thoracic clamps. Once reduction is complete defin
itive contoured rods are inserted to maintain the correction while fusion t
akes place. This method appears less hazardous by eliminating sagittal tran
slation, and may reduce the risk of neurological injury during surgery. It
achieves rigid internal fixation, obviating the need for a halo vest in the
postoperative period.