What are the indications for spinal osteotomy in patients with AS

Cervical spine osteotomy is indicated for fixed flexion deformity of the cervical region. In the most severe case, a chin-on-chest deformity is present. Cervical deformities impair the ability to maintain a forward gaze, cause difficulty with personal hygiene, and lead to swallowing difficulty. Because cervical osteotomy is a high-risk procedure, patients should have an earnest desire to accept the risks and rehabilitative measures required for surgical correction.

Kyphotic deformity of the thoracic spine in AS does not usually reach proportions that require surgical correction. Combined anterior and posterior approaches are necessary in rare cases that require surgical correction. The diaphragm must not be violated because patients breathe solely with the diaphragm due to absence of motion through the costovertebral joints.

Osteotomy of the lumbar spine is commonly done for AS patients with fixed flexion deformities due to lumbar hypolordosis or lumbar kyphosis.

Patients with fixed flexion deformities of the hip joints secondary to hip arthrosis should be considered for total hip replacement before a spinal osteotomy procedure is considered.

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