Management of cervical deformity in ankylosing spondylitis

Abstract

<jats:p>✓ 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.</jats:p>

A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction

“…Numerous previous reports have described osteotomy techniques for the lumbar spine that are commonly applied in an analogous fashion to the cervical spine, 15,17,36,40 and several of these would be classified within the Grade 2 osteotomy category. These include the Smith-Petersen osteotomy, 54 which involves wide resection of the posterior elements, including the lamina and bilateral facets, and, as initially described, was applied to multiple levels through previously fused facets in upper levels of the lumbar spine.…”

“…Likely due to the complexity and risk of Grade 7 osteotomies, as well as the relatively limited indications, few reports of these osteotomies exist. 10,11,15,17 Nomenclature Reliability Based on the proposed nomenclature, a reliability study was performed using 25 clinical cases that were graded by 11 readers with expertise in CSD diagnosis and treatment. The readers were experienced cervical and thoracolumbar deformity surgeons and members of a large multicenter deformity study group.…”

Ankylosing spondylitis: recent developments and anaesthetic implications

“…Treatment of severe cervical kyphosis may ultimately require surgical correction. These surgical procedures present a wide range of challenges to the anaesthetist [47]. A thorough pre-operative assessment is essential to evaluate the severity of the disease, in particular airway involvement and the extra-articular manifestations of the disease.…”

“…Several case reports of significant postoperative neurological deficits associated with normal intra-operative SSEPs have been published. [47]. MEPs are used to complement SSEP monitoring to detect potential damage to the corticospinal (motor) tracts of the spinal cord.…”

“…The relatively large voltage of MEP enables instantaneous monitoring because signal averaging is not required. Following extension of the neck during corrective surgery decreases in the amplitude of MEPs actuates immediate corrective measures [47].…”