Li Jun, Li Fang-Cai, Chen Qi-Xin
Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, China.
Eur Spine J. 2022 Dec;31(12):3768-3775. doi: 10.1007/s00586-022-07364-y. Epub 2022 Sep 28.
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.
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.
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.
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.
强直性脊柱炎（AS）相关的严重颈椎轴向畸形在临床上较为罕见，且对AS相关轴向畸形的手术治疗关注较少。本病例研究旨在展示颈椎旋转截骨术的手术技术。
我们报告了一例年轻的AS患者，其颈部以18°的左旋姿势固定，需要躯干向右转才能向前直视。这使他的步态显得跛行，给他带来极大不便。为了纠正这种畸形，我们通过一期后-前-后入路进行了一种新型的颈椎旋转截骨术。首先，我们进行了C7和T1的椎板切除术，接着进行了C7/T1小关节切除术并松解双侧C8神经根。然后，我们进行了C7/T1椎间盘切除术、椎体外侧和钩椎关节的骨质切除。随后手动旋转患者头部，使其面部和躯干同时向前。最后，固定跨越从C6到T2螺钉的棒。
术后，患者的轴向排列明显改善，能够正常行走。在3年的随访中手术效果得到良好维持。
通过本病例，我们希望引起对脊柱轴向畸形的关注，并为脊柱轴向畸形的手术治疗提供一个参考点。
