New approach to cervical flexion deformity in ankylosing spondylitis - Case report

The treatment of cervical fixed flexion deformity in ankylosing spondylitis presents a challenging problem that is traditionally managed by a correcti ve cervicothoracic osteotomy. The authors report a new approach to this pro blem that involves performing a two-level osteotomy at the level of maximum spinal curvature, thereby achieving complete anatomical correction in a on e-stage procedure. This 48-year-old woman with ankylosing spondylitis presented with a 30-year history of progressive neck deformity that left her unable to see ahead an d caused her to experience difficulty eating, drinking, and breathing on ex ertion. On examination, she exhibited a 90 degrees fixed flexion deformity of the cervical spine, which was maximum at C-4; this was confirmed on imag ing studies. A two-level osteotomy was performed at C3-4 and C4-5 around the area of max imum spinal curvature, and the deformity was corrected by extending the hea d on its axis of rotation through the uncovertebral joints. The spine was s tabilized using a Ransford loop. An excellent anatomical position was achie ved, as was complete correction of the deformity. A two-level midcervical osteotomy performed at the level of maximum spinal curvature in ankylosing spondylitis enables complete correction of severe f ixed flexion deformity in a single procedure. Preservation of the uncoverte bral joints allows smooth and safe correction of the deformity about their axis of rotation.