ABSTRACT
Unsatisfactory results, neurological deficits, and in some instances life-threatening complications have made patients and doctors hesitant to decide for surgery in ankylosing spondylitis (AS) (1–4). However, decisive progress in surgical technique has been made toward fewer complications, less operative trauma, and better quality of life after surgery (5–7). Somatosensory evoked potential (SSEP)-monitoring allows continuous control of some functions of the spinal cord during surgery. Emphasis in this report is given to the benefits of improved instrumentation systems and better imaging studies which have made preoperative assessment and surgery of the cervical spine in ankylosing spine safer and more successful. We report on 66 AS patients (mean age: 49.4 years; male:female: 58:8) with cervical disorders treated in our institution in the period between 1994 and 2003. The material comprised subaxial disorders in the form of kyphosis in 31 patients, fractures and posttraumatic deformity in 26 patients and atlantoaxial instability and/or dislocation C1/C2 in the remaining nine patients. Surgery resulted in excellent correction of the disturbed sagittal profile with adequate stability and restoration of a horizontal axis of vision. Loosening of the screws with loss of the correction was encountered in one patient of cervicothoracic osteotomy and was successfully restored after a revision surgery. No mortalities or cord dysfunction were encountered. However, the most serious complication, partial sensory and/or motor deficit of root origin, was seen in eight patients. The C8 root was involved in six patients, followed by the C5 root in the remaining two. Remission (four patients) or substantial recovery (three patients) occurred in seven patients during the first three months after surgery.
