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Cervicothoracic Kyphosis in Ankylosing Spondilitis

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Spine Surgery

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Abstract

Ankylosing spondylitis (AS) is a chronic inflammatory disease that particularly affects the spine. Due to its widespread ankylosis patients are predisposed to development of a rigid, kyphotic deformity most commonly in thoracolumbar region. However, the cervical and cervicothoracic spine can also be affected. We describe a case of post-traumatic, chin-on-chest deformity in patient with AS, successfully corrected by osteotomy and long-posterior fixation across cervicothoracic junction. Indications, preparations and technical aspects of the surgery as medical and neurological considerations are explained in step-by-step fashion.

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References

  1. Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369(9570):1379–90.

    Article  Google Scholar 

  2. Vaccaro AR, Koerner JD, Radcliff KE, et al. AOSpine subaxial cervical spine injury classification system. Eur Spine J. 2016;25(7):2173–84.

    Article  Google Scholar 

  3. Simmons ED, Distefano RJ, Zheng Y, Simmons EH. Thirty-six years experience of cervical extension osteotomy in ankylosing spondylitis: techniques and outcomes. Spine (Phila Pa 1976). 2006;31(26):3006–12.

    Article  Google Scholar 

  4. Maxwell LJ, Zochling J, Boonen A, et al. TNF-alpha inhibitors for ankylosing spondylitis. Cochrane Database Syst Rev. 2015;4:CD005468.

    Google Scholar 

  5. Tymms K, Littlejohn G, Griffiths H, et al. Treatment patterns among patients with rheumatic disease (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and undifferentiated arthritis (UnA)) treated with subcutaneous TNF inhibitors. Clin Rheumatol. 2018;37:1617–23.

    Article  Google Scholar 

  6. Finkelstein JA, Chapman JR, Mirza S. Occult vertebral fractures in ankylosing spondylitis. Spinal Cord. 1999;37(6):444–7.

    Article  CAS  Google Scholar 

  7. Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010;35(11):E458–64.

    Article  Google Scholar 

  8. Deviren V, Scheer JK, Ames CP. Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases. J Neurosurg Spine. 2011;15(2):174–81.

    Article  Google Scholar 

  9. Samudrala S, Vaynman S, Thiayananthan T, et al. Cervicothoracic junction kyphosis: surgical reconstruction with pedicle subtraction osteotomy and smith-Petersen osteotomy. Presented at the 2009 joint spine section meeting. Clinical article. J Neurosurg Spine. 2010;13(6):695–706.

    Article  Google Scholar 

  10. Theologis AA, Tabaraee E, Funao H, et al. Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients. Eur Spine J. 2015;24(Suppl 1):S23–30.

    Article  Google Scholar 

  11. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res. 1969;66:6–9.

    CAS  PubMed  Google Scholar 

  12. Urist MR. Osteotomy of the cervical spine; report of a case of ankylosing rheumatoid spondylitis. J Bone Joint Surg Am. 1958;40-A(4):833–43.

    Article  CAS  Google Scholar 

  13. Law WA. Osteotomy of the cervical spine. J Bone Joint Surg Br. 1959;41-B:640–1.

    Article  CAS  Google Scholar 

  14. Simmons EH. The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis. Clin Orthop Relat Res. 1972;86:132–43.

    Article  CAS  Google Scholar 

  15. Tokala DP, Lam KS, Freeman BJ, Webb JK. C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis. Eur Spine J. 2007;16(9):1471–8.

    Article  Google Scholar 

  16. Wollowick AL, Kelly MP, Riew KD. Pedicle subtraction osteotomy in the cervical spine. Spine (Phila Pa 1976). 2012;37(5):E342–8.

    Article  Google Scholar 

  17. Ames CP, Smith JS, Scheer JK, et al. A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article. J Neurosurg Spine. 2013;19(3):269–78.

    Article  Google Scholar 

  18. Suk KS, Kim KT, Lee SH, Kim JM. Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976). 2003;28(17):2001–5.

    Article  Google Scholar 

  19. Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013;19(2):141–59.

    Article  Google Scholar 

  20. Etame AB, Than KD, Wang AC, La Marca F, Park P. Surgical management of symptomatic cervical or cervicothoracic kyphosis due to ankylosing spondylitis. Spine (Phila Pa 1976). 2008;33(16):E559–64.

    Article  Google Scholar 

  21. McMaster MJ. Osteotomy of the cervical spine in ankylosing spondylitis. J Bone Joint Surg Br. 1997;79(2):197–203.

    Article  CAS  Google Scholar 

  22. Langeloo DD, Journee HL, Pavlov PW, de Kleuver M. Cervical osteotomy in ankylosing spondylitis: evaluation of new developments. Eur Spine J. 2006;15(4):493–500.

    Article  Google Scholar 

  23. Belanger TA, Milam RA, Roh JS, Bohlman HH. Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis. J Bone Joint Surg Am. 2005;87(8):1732–8.

    PubMed  Google Scholar 

  24. Hoh DJ, Khoueir P, Wang MY. Management of cervical deformity in ankylosing spondylitis. Neurosurg Focus. 2008;24(1):E9.

    Article  Google Scholar 

  25. Ito Y, Sugimoto Y, Tomioka M, Hasegawa Y, Nakago K, Yagata Y. Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. J Neurosurg Spine. 2008;9(5):450–3.

    Article  Google Scholar 

  26. Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D. Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths. Spine J. 2006;6(6):667–72.

    Article  Google Scholar 

  27. Khoueir P, Hoh DJ, Wang MY. Use of hinged rods for controlled osteoclastic correction of a fixed cervical kyphotic deformity in ankylosing spondylitis. J Neurosurg Spine. 2008;8(6):579–83.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Bernhard Meyer

  2. Department of Orthopedics, Spine Unit, Umeå University Hospital, Umeå, Sweden

    Lukas Bobinski

Authors
  1. Bernhard Meyer
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  2. Lukas Bobinski
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Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Bernhard Meyer

  2. Department of Spine Surgery, Sana Klinikum Offenbach, Offenbach, Germany

    Michael Rauschmann

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Meyer, B., Bobinski, L. (2019). Cervicothoracic Kyphosis in Ankylosing Spondilitis. In: Meyer, B., Rauschmann, M. (eds) Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-98875-7_53

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  • DOI: https://doi.org/10.1007/978-3-319-98875-7_53

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98874-0

  • Online ISBN: 978-3-319-98875-7

  • eBook Packages: MedicineMedicine (R0)

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