Hoh Daniel J, Khoueir Paul, Wang Michael Y
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Neurosurg Focus. 2008;24(1):E9. doi: 10.3171/FOC/2008/24/1/E9.
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.
强直性脊柱炎可导致严重的颈椎后凸，引起前方视野、吞咽、个人卫生、患者功能及社会前景等方面的问题。对颈椎屈曲畸形患者的评估包括整体矢状面平衡及眉-颌角的评估。极端致残病例的主要治疗方法是手术矫正，包括后路颈椎伸展截骨术，这是一项技术要求高且有相当大神经损伤风险的手术。为应对伸展截骨术的潜在并发症，多篇报告的作者描述了手术技术的改进。这些进展纳入了麻醉、神经监测及脊柱内固定方面的最新成果。与该手术相关的并发症包括截骨水平的半脱位、脊髓损伤、神经根病、吞咽困难及假关节形成。尽管脊柱矫正的风险很大，但伸展截骨术仍是颈椎屈曲畸形致残患者的一种有效治疗方式。
