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

J Neurosurg. 2000 Oct;93(2 Suppl):283-6. doi: 10.3171/spi.2000.93.2.0283.


The treatment of cervical fixed flexion deformity in ankylosing spondylitis presents a challenging problem that is traditionally managed by a corrective cervicothoracic osteotomy. The authors report a new approach to this problem that involves performing a two-level osteotomy at the level of maximum spinal curvature, thereby achieving complete anatomical correction in a one-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 and caused her to experience difficulty eating, drinking, and breathing on exertion. On examination, she exhibited a 90 degrees fixed flexion deformity of the cervical spine, which was maximum at C-4; this was confirmed on imaging studies. A two-level osteotomy was performed at C3-4 and C4-5 around the area of maximum spinal curvature, and the deformity was corrected by extending the head on its axis of rotation through the uncovertebral joints. The spine was stabilized using a Ransford loop. An excellent anatomical position was achieved, 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 fixed flexion deformity in a single procedure. Preservation of the uncovertebral joints allows smooth and safe correction of the deformity about their axis of rotation.

Publication types

  • Case Reports

MeSH terms

  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / surgery*
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Internal Fixators
  • Middle Aged
  • Neurosurgery / trends
  • Osteotomy / methods*
  • Spondylitis, Ankylosing / diagnostic imaging
  • Spondylitis, Ankylosing / surgery*
  • Tomography, X-Ray Computed