Spine Surgery pp 353-361 | Cite as

Treatment Options in Severe Cervico-Thoracal Deformity in “Bechterew’s Disease”

  • George K. Prezerakos
  • Adrian T. H. Casey


Cervical deformity though uncommon, can result in significant limitations in physical function and everyday life activities. It usually occurs in the sagittal plane partly because of the cervical spine biomechanics (less load dispersed to the anterior column) and partly because of the nature of the underlying causes, which are usually kyphogenic [1]. The spectrum of clinical manifestations includes at one end neck pain and various levels of neurological deficit myelopathy or radiculopathy, to loss of horizontal gaze, swallowing difficulties, self-feeding and self-dressing difficulties and maintaining hygiene [2, 3].


  1. 1.
    Etame AB, Wang AC, Than KD, et al. Outcomes after surgery for cervical spine deformity: review of the literature. Neurosurg Focus. 2010;28:E14. Scholar
  2. 2.
    Hu X, Thapa AJ, Cai Z, et al. Comparison of smith-petersen osteotomy, pedicular subtraction osteotomy, and poly-segmental wedge osteotomy in treating rigid thoracolumbar kyphotic deformity in ankylosing spondylitis a systematic review and meta-analysis. BMC Surg. 2016;16:4. Scholar
  3. 3.
    McMaster MJ. Osteotomy of the cervical spine in ankylosing spondylitis. J Bone Joint Surg Br. 1997;79:197–203.CrossRefGoogle Scholar
  4. 4.
    Kubiak EN, Moskovich R, Errico TJ, Di Cesare PE. Orthopaedic management of ankylosing spondylitis. J Am Acad Orthop Surg. 2005;13:267–78.CrossRefGoogle Scholar
  5. 5.
    Steinmetz MP, Stewart TJ, Kager CD, et al. Cervical deformity correction. Neurosurgery. 2007;60:S90–7. Scholar
  6. 6.
    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;13:695–706. Scholar
  7. 7.
    Deutsch H, Haid RW, Rodts GE, Mummaneni PV. Postlaminectomy cervical deformity. Neurosurg Focus. 2003;15:E5.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Gerling MC, Bohlman HH. Dropped head deformity due to cervical myopathy: surgical treatment outcomes and complications spanning twenty years. Spine. 2008;33:E739–45. Scholar
  9. 9.
    Suk K-S, Kim K-T, Lee S-H, Kim J-M. Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine. 2003;28:2001–5. Scholar
  10. 10.
    Tokala DP, Lam KS, Freeman BJC, Webb JK. C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis. Eur Spine J. 2007;16:1471–8. Scholar
  11. 11.
    Anderson DG, Silbert J, Albert TJ. Management of cervical kyphosis caused by surgery, degenerative disease, or trauma. In: The Cervical Spine, 4th ed. Lippincott Williams & Wilkins: Philadephia, PA; 2005, p. 1135–46.Google Scholar
  12. 12.
    Grosso MJ, Hwang R, Krishnaney AA, et al. Complications and outcomes for surgical approaches to cervical kyphosis. J Spinal Disord Tech. 2015;28:E385–93. Scholar
  13. 13.
    Simmons ED, DiStefano RJ, Zheng Y, Simmons EH. Thirty-six years experience of cervical extension osteotomy in ankylosing spondylitis: techniques and outcomes. Spine. 2006;31:3006–12. Scholar
  14. 14.
    Belanger TA, Milam RAI, Roh JS, Bohlman HH. Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis. JBJS. 2005;87:1732.Google Scholar
  15. 15.
    Kim K-T, Park D-H, Lee S-H, Lee J-H. Results of corrective osteotomy and treatment strategy for ankylosing spondylitis with kyphotic deformity. Clin Orthop Surg. 2015;7:330–6. Scholar
  16. 16.
    Briggs H, Keats S, Schlesinger PT. Wedge osteotomy of the spine with bilateral intervertebral foraminotomy; correction of flexion deformity in five cases of ankylosing arthritis of the spine. J Bone Joint Surg Am. 1947;29:1075–82.PubMedGoogle Scholar
  17. 17.
    La Chapelle EH. Osteotomy of the lumbar spine for correction of kyphosis in a case of ankylosing spondylarthritis. J Bone Joint Surg Am. 1946;28:851–8.PubMedGoogle Scholar
  18. 18.
    Kim HJ, Piyaskulkaew C, Riew KD. Comparison of Smith-Petersen osteotomy versus pedicle subtraction osteotomy versus anterior-posterior osteotomy types for the correction of cervical spine deformities. Spine. 2015;40:143–6. Scholar
  19. 19.
    Etame AB, Than KD, Wang AC, et al. Surgical management of symptomatic cervical or cervicothoracic kyphosis due to ankylosing spondylitis. Spine. 2008;33:E559–64. Scholar
  20. 20.
    Langeloo DD, Journee HL, Pavlov PW, de Kleuver M. Cervical osteotomy in ankylosing spondylitis: evaluation of new developments. Eur Spine J. 2006;15:493–500. Scholar
  21. 21.
    OCEBM levels of evidence – CEBM. Accessed 30 Apr 2018.
  22. 22.
    Simmons EH. The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis. Clin Orthop Relat Res. 1972;86:132–43.CrossRefGoogle Scholar
  23. 23.
    Lau D, Ziewacz JE, Le H, et al. A controlled anterior sequential interbody dilation technique for correction of cervical kyphosis. J Neurosurg Spine. 2015;23:263–73. Scholar
  24. 24.
    Wang VY, Aryan H, Ames CP. A novel anterior technique for simultaneous single-stage anterior and posterior cervical release for fixed kyphosis: technical note. J Neurosurg Spine. 2008;8:594–9. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • George K. Prezerakos
    • 1
  • Adrian T. H. Casey
    • 1
  1. 1.Victor Horsley Department of NeurosurgeryThe National Hospital for Neurology and NeurosurgeryQueen Square, LondonUK

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