Update on Surgery for Cervical Flexion in Ankylosing SpondylitisSurgical procedures change over time with improvements in equipment and techniques. In this article, surgeons report on the results of an operation for extreme neck flexion in 131 patients with ankylosing spondylitis (AS).
AS is an inflammatory condition of the tendons where they attach to the bone. Joint pain, loss of motion, and a bent position of the spine are common problems with AS. The patients in this study had a severe flexion deformity of the cervical spine (neck). They were unable to see ahead where they were going. Swallowing and personal hygiene were difficult.
The authors describe two methods used to correct this problem. In both operations, a wedge of bone is removed from the back of the bone. The wedge of bone is then used to correct the angle of the spine. The operation is called a cervical osteotomy. A traction halo device is used to straighten the patient's spine into a more upright position.
The conventional method was used up until 1997. Patients were required to come in one to two days before surgery to have the halo fitted in advance. Since that time, a more current method has been used. The current technique removes more bone along the sides in a one-step operation. The bone is removed and the halo installed in the same operation.
The halo has a rigid plastic body jacket or vest. Vertical steel rods or posts attached to the vest support a device that fits across the forehead and around the head like a halo. Four steel screws attach the halo directly to the outer skull to hold the head and neck in place. The halo system stabilizes the cervical spine while healing takes place.
The current method reduced the average hospital stay from 33 days to six days. The larger bone resection and increased correction angle decreases the risk of pressure on the nerve. It also increases space where the spinal cord might wrinkle or bunch up.
The authors note that the new procedure still has high risks for the patient and should only be done by an experienced surgeon.
Edward D. Simmons, MD, et al. Thirty-six Years Experience of Cervical Extension Osteotomy in Ankylosing Spondylitis. In Spine. December 15, 2006. Vol. 31. No. 26. Pp. 3006-3012.
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