Surgical options in the treatment of the spinal disorders in ankylosing spondylitis.

Serious complications or unsatisfactory results in the past often have made patients as well as doctors hesitant to decide for surgery in ankylosing spondylitis. Though the techniques of correction for fixed flexion deformity still are demanding, decisive progress has been made toward less complications, less operative trauma and better quality of life after surgery. The present work represents a short review of the evolution of surgical techniques in treatment of spinal disorders encountered in ankylosing spondylitis. Emphasis is given to the benefits of improved instrumentation systems, intraoperative navigation, spinal cord monitoring and endoscopic surgery done in the prone position in completing the circumferential osteotomy of the thoracolumbar and lumbar spine in a safe and successful way. Fifty patients with deformities in the lumbar and thoracolumbar spine and 34 with deformities in the cervical spine were treated by instrumented corrective osteotomies. Excellent correction of the disturbed sagittal profile with restoration of a horizontal axis of vision was achieved in all of them. Neurological deterioration occurred in seven patients and was completely reversible in five of them.