Purpose

Severe cervical axial deformity associated with ankylosing spondylitis (AS) is rare in clinic, and there are little concerns about surgical treatment of axial deformity associated with AS. The case study aims to show the surgical technique to perform cervical rotational osteotomy.

Methods

We present the case of a young AS patient whose neck was fixed in a left-rotational posture at 18°, requiring his trunk to be turned to the right to look forward visually. This made his gait appear to be limping, inconveniencing him with great difficulty. In order to correct this deformity, we performed a novel cervical rotational osteotomy through a one-stage posterior–anterior–posterior approach. Firstly, we performed laminectomies of C7 and T1, followed by a C7/T1 facetectomy with release of the bilateral C8 nerve roots. Next, we performed C7/T1 discectomy, bony resection of the lateral body and uncovertebral joints. The head of the patient was then rotated manually, so that both his face and torso were simultaneously facing frontward. Finally, rods spanning the screws from C6 to T2 were fixed.

Results

Postoperatively, the patient’s axial malalignment was significantly improved, and he was able to walk normally. Surgical outcomes were well maintained at a 3-year follow-up.

Conclusion

Through this case, we hope to draw the attention to spinal axial deformity and provide a reference point in the surgical treatment of spinal axial deformity.

中文翻译：

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颈椎旋转截骨矫正强直性脊柱炎患者轴向​​畸形

目的

强直性脊柱炎（ankylosing spondylitis，AS）相关的严重颈椎轴向畸形在临床上少见，对AS相关轴向畸形的手术治疗关注度较低。该案例研究旨在展示进行颈椎旋转截骨术的手术技术。

方法

我们介绍了一位年轻 AS 患者的案例，他的脖子固定在 18° 的左旋姿势，需要他的躯干向右转动以目视前方。这让他的步态显得一瘸一拐，让他很不方便。为了矫正这种畸形，我们通过一期后-前-后入路进行了新型颈椎旋转截骨术。首先，我们进行了 C7 和 T1 的椎板切除术，然后是 C7/T1 小关节切除术，松解了双侧 C8 神经根。接下来，我们进行了 C7/T1 椎间盘切除术、外侧体和钩椎关节的骨切除术。然后手动旋转患者的头部，使他的脸和躯干同时面向前方。最后，固定横跨从 C6 到 T2 的螺钉的杆。

结果

术后，患者轴向畸形明显改善，可正常行走。在 3 年的随访中，手术结果保持良好。

结论

希望通过本病例引起人们对脊柱中轴畸形的重视，为脊柱中轴畸形的手术治疗提供参考依据。