Controlled Cervical Extension Osteotomy for Ankylosing Spondylitis Utilizing the Jackson Operating Table

Abstract

Technical note. To demonstrate a controlled extension osteotomy technique of the cervical spine in a prone position and using the head elevator mechanism on the Jackson operating table to correct a chin-on-chest deformity in a patient with ankylosing spondylitis. Catastrophic cord injury causing quadriplegia and death has been associated with correction of chin-on-chest deformity in patients with ankylosing spondylitis. Manual control of spinal column motion during and after osteoclasis or osteotomy can be difficult, inexact, and anxiety inducing. A 45-year-old woman with ankylosing spondylitis and severe chin-on-chest deformity underwent a posterior C7 pedicle subtraction osteotomy, deformity correction, and instrumented fusion in a prone position on the Jackson operating table. By using the elevator mechanism attached to the head of the operating table and Mayfield tongs, the patient's cervicothoracic junction was placed into extension by over 30 degrees in controlled increments. We present a technique for controlled extension osteotomy correction of chin-on-chest deformity in a prone position. Use of the operating table mechanism in conjunction with a closing-wedge osteotomy diminishes the risk of translation, decreases risk of air embolus associated with a sitting position, and promotes greater opportunity for fusion through the osteotomy, and the stability allows for placement of modern instrumentation.