Cervical osteotomy for ankylosing spondylitis: an innovative variation on an existing technique

Mehdian, S. M. H.; Freeman, Brian J. C.; Licina, P.

doi:10.1007/s005860050215

Cited by 44 publications

(32 citation statements)

References 11 publications

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“…There are a number of disadvantages however with this technique: (1) at the point of correction the patient is given a brief anaesthetic thereby losing subjective spinal cord monitoring, (2) lack of airway control in the event of sudden emergencies, (3) risk of air embolism, and (4) difficulty in managing hypotension. Due to the advances in fibre optic intubation and somatosensory and motor evoked potential monitoring, general anaesthesia is now favoured by the patient, surgeon and the anaesthetist [5,7,9].…”

Section: Discussionmentioning

confidence: 99%

“…Halo-jacket without internal fixation after osteotomy has been found to be inadequate for immobilisation [7,9], hence the addition of internal fixation can prevent displacement and loss of correction postoperatively. Although Shimizu et al [12] and Mc Master [7] initially used sub-laminar wires, due to the ankylosis of posterior bony elements and possibility of tearing underlying adherent dura, they are no longer used.…”

Section: Discussionmentioning

confidence: 99%

“…Although Shimizu et al [12] and Mc Master [7] initially used sub-laminar wires, due to the ankylosis of posterior bony elements and possibility of tearing underlying adherent dura, they are no longer used. Lateral mass and thoracic pedicle screws with rods have been used more recently [4,9].…”

Section: Discussionmentioning

confidence: 99%

“…However, in patients with advanced disease causing a fixed deformity, the only treatment available is a corrective extension osteotomy [7,9].…”

Section: Introductionmentioning

confidence: 99%

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C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis

et al. 2007

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Our objective is to report on the clinical and radiological outcome following a decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis in patients with ankylosing spondylitis. The only treatment available for severe fixed flexion deformity of the cervical spine in these patients is an extension osteotomy. Traditionally an anterior opening, posterior closing wedge osteotomy is performed with or without internal fixation. We describe a decancellisation closing wedge osteotomy of C7 accompanied by secure segmental internal fixation. Eight patients operated between 1990 and 2003 with mean age of 54 years and minimum follow up of 2 years were retrospectively evaluated. Restoration of normal forward gaze was achieved in all patients. No patient suffered spinal cord injury or permanent nerve root palsy. There was no loss of correction or pseudarthrosis at final follow up. C7 decancellisation closing wedge osteotomy supplemented with secure segmental internal fixation in experienced hands provides a safe and effective treatment for fixed cervico-thoracic kyphosis in patients with ankylosing spondylitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…However, in patients with advanced disease causing a fixed deformity, the only treatment available is a corrective extension osteotomy [7,9].…”

Section: Introductionmentioning

confidence: 99%

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C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis

et al. 2007

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“…1,7,9,11,13,14,19 The benefits of performing the osteotomy at the cervicothoracic junction include a wider spinal canal, sparing of upper-extremity function in event of a cord injury, and vertebral artery anatomy relative to C-7. Posterior extension osteotomy has been performed, however, at midcervical levels.…”

Section: Level Of Osteotomymentioning

confidence: 99%

Management of cervical deformity in ankylosing spondylitis

Hoh

Khoueir

Wang

2008

FOC

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✓ Ankylosing spondylitis can lead to severe cervical kyphosis, causing problems with forward vision, swallowing, hygiene, patient functionality, and social outlook. Evaluation of patients with cervical flexion deformity includes assessment of global sagittal balance and chin–brow angle. The primary treatment in extreme disabling cases is surgical correction involving a posterior cervical extension osteotomy, which is a technically demanding procedure with considerable risk of neurological injury. To address the potential complications with extension osteotomy, the authors of several reports have described modifications to the surgical technique. These developments incorporate recent advances in anesthesia, neuromonitoring, and spinal instrumentation. Complications associated with the procedure include subluxation at the osteotomy level, spinal cord injury, radiculopathy, dysphagia, and pseudarthrosis. Although the risks of spinal correction are considerable, extension osteotomy remains an effective treatment modality for patients with disabling cervical flexion deformity.

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