Correction and stabilisation in ankylosing spondylitis of the cervicothoracic spine

Abstract

Introduction The ankylosing spondylitis is an inflammatory disease affecting more or less the whole spine with quite significant secondary problems like severe kyphosis and inability to correct spontaneously this kyphosis due to the ankylosis. If the kyphosis is mostly in the cervicothoracic spine, patients tend to look towards the floor and are unable to have a horizontal view. Depending on where the major deformity lies, different osteotomies of the spine are possible, mostly in the area of the upper lumbar spine or, as in this specific case presented in this series, an osteotomy at the lower cervical spine (C6/7). This osteotomy has been demonstrated many years ago, first by Ed Simmons in Toronto, where he did osteotomies in local anaesthesia and in sitting position, in order to control the neurological function during the osteotomy procedure. Since then, with modern instrumentation technology, it has become possible to do this osteotomy in prone position and to fix the corrected spine with a powerful pedicular system instead of treating the patient over weeks and months in a Halo jacket. These patients are operated without a wake-up test and in general anaesthesia, under continuous neuromonitoring in order to control the neurological function whilst the extension osteotomy in the lower cervical spine is conducted. Case description The patient is a 60-year-old male who suffers from an ankylosing spondylitis. His forward vision is quite disturbed by the deformity and he is unable to look straight forward. The X-rays show a classical bamboo spine and a significant kyphosis at the cervicothoracic junction which explains the patient’s clinical appearance.