Cervical osteotomy for the flexed cervical spine in ankylosing spondylitis

Patients with ankylosing spondylitis characteristically develop a thoracic kyphosis associated with flattening of the lumbar lordosis, but a proportion develop severe fixed flexion deformity of the neck. Few previous reports exist of planned surgical correction, reflecting the fear of catastrophic complications. Seven patients have undergone cervical osteotomy. Fibreoptic bronchoscopy allowed safe and predictable general anaesthesia, by permitting endotracheal intubation in conscious patients. Osteotomy corrected deformity to restore horizontal gaze in all patients. Mean correction of deformity was 31 degrees. There were no major neurological complications and all had satisfactory results 1-4 years after operation.