This article presents the current concepts of correction of spinal deformity in ankylosing spondylitis (AS) patients. Untreated AS can be a debilitating disease. In a few patients, disease progression results in severe spinal deformity affecting not only the thoracolumbar, but also the cervical spine. Surgery for correction in AS patients has a long history. With the advent of modern instrumentation, standardization of surgical and anesthesiologic techniques, surgical safety and corrective results could be improved and experiences from lumbar osteotomies could be transferred to the cervical spine. This article presents the current concepts of correction of spinal deformity in AS patients. In particular, questions regarding the localization and number of osteotomies, the optimal surgical target angle as well as planning and prediction of postoperative alignment are discussed. Insight into recent technical developments, current challenges with correction and geometric analysis of center of rotation (COR) in cervical 3-column osteotomies (3CO) will be presented. The article should encourage readers to improve surgical correction efficacy and provide a better understanding of correction geometry in 3CO for thoracolumbar and cervical spinal deformities.

Osteotomies in ankylosing spondylitis: where, how many, and how much?

Cervical laminectomy is a reliable tool for posterior decompression in various cervical spine pathologies. Although there is increasing evidence of superior clinical, neurological and radiological outcomes when using anterior cervical decompression, laminectomy can be a valuable tool when combined with instrumented lateral mass fusion for carefully selected indications. Literature review. This review article will provide decision-making guidance, technical advices and pitfalls. The technical advice for laminectomy and instrumented lateral mass fusion is illustrated. The authors review the literature on outcomes and complications and suggest indications for the safe and successful application of cervical laminectomy and lateral mass fusion.

Cervical laminectomy and instrumented lateral mass fusion: techniques, pearls and pitfalls

The aim of the present study was to investigate the factors associated with axial symptom using multivariable analysis. The authors retrospectively assessed 249 patients treated by open-door laminoplasty. The patients were classified into two groups: axial symptom and no axial symptom group. The possible factors included demographic variables (age, sex, BMI, smoking, heart disease, diabetes, preoperative neck pain, preoperative JOA scores, preoperative NDI, course of disease and pathogenesis) and surgical and radiological variables [operation time, intraoperative blood loss, collar wear time, preoperative cervical curvature, postoperative cervical curvature, T1 slope, preoperative and postoperative C2 sagittal vertical axis (C2 SVA)]. The prevalence of axial symptom was 34.9% (89/249). The collar wear time, preoperative and postoperative C2 SVA were risk factors for axial symptom. A cutoff value of 22.6 mm for preoperative C2 SVA and 3.5 weeks for collar wear time predicted the development of axial symptom. The longer collar wear time, larger preoperative and postoperative C2 SVA were positively correlated with the higher incidence of axial symptom.

Factors associated with postoperative axial symptom after expansive open-door laminoplasty: retrospective study using multivariable analysis.

Effects of durotomy versus myelotomy in the repair of spinal cord injury.

Severe Fixed Cervical Kyphosis Treated with Circumferential Osteotomy and Pedicle Screw Fixation Using an Anterior-Posterior-Anterior Surgical Sequence

Object Previous studies have shown that cervical and thoracic kyphotic deformity increases spinal cord intramedullary pressure (IMP). Using a cadaveric model, the authors investigated whether posterior decompression can adequately decrease elevated IMP in severe cervical and thoracic kyphotic deformities. Methods Using an established cadaveric model, a kyphotic deformity was created in 16 fresh human cadavers (8 cervical and 8 thoracic). A single-level rostral laminotomy and durotomy were performed to place intraparenchymal pressure monitors in the spinal cord at C-2, C4–5, and C-7 in the cervical study group and at T4–5, T7–8, and T11–12 in the thoracic study group. Intramedullary pressure was recorded at maximal kyphosis. Posterior laminar, dural, and pial decompressions were performed while IMP was monitored. In 2 additional cadavers (1 cervical and 1 thoracic), a kyphotic deformity was created and then corrected. Results The creation of the cervical and thoracic kyphotic deformities resulted in signif...

Laminectomy, durotomy, and piotomy effects on spinal cord intramedullary pressure in severe cervical and thoracic kyphotic deformity: a cadaveric study.

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Laminectomy, durotomy, and piotomy effects on spinal cord intramedullary pressure in severe cervical and thoracic kyphotic deformity: a cadaveric study.