Surgical treatment of "chin-on-pubis" deformity in a patient with ankylosing spondylitis: A case report of consecutive cervical, thoracic, and lumbar corrective osteotomies

Ki Tack Kim, Sang Hun Lee, Eun Seok Son, Yoon Ho Kwack, Young Soo Chun, Jae Hoon Lee

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN. A case report. OBJECTIVE. To report the successful consecutive spinal osteotomies of multiple segments performed on a patient with extremely severe kyphotic deformity. SUMMARY OF BACKGROUND DATA. There have been no reports on the experience and surgical strategy of spinal osteotomy on multiple segments for severe global spine deformity. METHODS. A 48-year-old man, a patient with ankylosing spondylitis with "chin-on-pubis" deformity, underwent consecutive spinal osteotomies to correct the severe, fixed global kyphosis. The axial skeletons from the skull, all vertebrae, and both sacroiliac joints and hip joint were fused into a single bone. After both hip resectional arthroplasties for the first step, staged, sequential spinal osteotomies, including pedicle subtraction osteotomy (PSO) on C6, posterior vertebral column resection on T11-T12, and PSO on L3, were performed. Finally, both total hip arthoroplasties were performed. RESULTS. The chin-brow vertical angle improved from 140° to 15°. Correction angles of 45°, 70°, and 30° in the cervical, thoracic, and lumbar spines, respectively, were achieved without complication. At the last follow-up, excellent improvement in activities of daily living and horizontal gaze were achieved. CONCLUSION. This is the first report on C6 PSO and spinal osteotomies in whole spine segments. For patients with a severe global kyphotic deformity, it is important to place the patient in a stable prone position so that corrective surgery can be performed on the thoracolumbar spine. To accomplish this, initially correcting the deformities in the hip joints and the cervical spine can yield excellent clinical results.

Original languageEnglish (US)
JournalSpine
Volume37
Issue number16
DOIs
StatePublished - Jul 15 2012
Externally publishedYes

Fingerprint

Pubic Bone
Chin
Ankylosing Spondylitis
Osteotomy
Thorax
Spine
Hip Joint
Therapeutics
Hip
Sacroiliac Joint
Prone Position
Kyphosis
Activities of Daily Living
Skull
Skeleton
Arthroplasty
Bone and Bones

Keywords

  • ankylosing spondylitis
  • chin-on-pubis deformity
  • global kyphosis
  • spinal osteotomy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Surgical treatment of "chin-on-pubis" deformity in a patient with ankylosing spondylitis : A case report of consecutive cervical, thoracic, and lumbar corrective osteotomies. / Kim, Ki Tack; Lee, Sang Hun; Son, Eun Seok; Kwack, Yoon Ho; Chun, Young Soo; Lee, Jae Hoon.

In: Spine, Vol. 37, No. 16, 15.07.2012.

Research output: Contribution to journalArticle

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abstract = "STUDY DESIGN. A case report. OBJECTIVE. To report the successful consecutive spinal osteotomies of multiple segments performed on a patient with extremely severe kyphotic deformity. SUMMARY OF BACKGROUND DATA. There have been no reports on the experience and surgical strategy of spinal osteotomy on multiple segments for severe global spine deformity. METHODS. A 48-year-old man, a patient with ankylosing spondylitis with {"}chin-on-pubis{"} deformity, underwent consecutive spinal osteotomies to correct the severe, fixed global kyphosis. The axial skeletons from the skull, all vertebrae, and both sacroiliac joints and hip joint were fused into a single bone. After both hip resectional arthroplasties for the first step, staged, sequential spinal osteotomies, including pedicle subtraction osteotomy (PSO) on C6, posterior vertebral column resection on T11-T12, and PSO on L3, were performed. Finally, both total hip arthoroplasties were performed. RESULTS. The chin-brow vertical angle improved from 140° to 15°. Correction angles of 45°, 70°, and 30° in the cervical, thoracic, and lumbar spines, respectively, were achieved without complication. At the last follow-up, excellent improvement in activities of daily living and horizontal gaze were achieved. CONCLUSION. This is the first report on C6 PSO and spinal osteotomies in whole spine segments. For patients with a severe global kyphotic deformity, it is important to place the patient in a stable prone position so that corrective surgery can be performed on the thoracolumbar spine. To accomplish this, initially correcting the deformities in the hip joints and the cervical spine can yield excellent clinical results.",
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