ABSTRACT
Ankylosing spondylitis (AS) is an important cause of fixed sagittal plane deformity of the spine. AS is a seronegative spondyloarthropathy with a high specificity for involvement of the spinal entheses, or attachments of joint capsules, ligaments, and tendons into bone. Characteristically, the axial skeleton including the sacroiliac joints and the spinal motion segments are affected by sterile inflammation, erosion, fibrosis, and ossification. Ankylosis of the spine results in significant and measurable disability and compromise of quality of life (1). There are three recognized phases of disease progression: inflammation, flexion deformity, and bony ankylosis (2). Medical management and postural exercises have not reliably changed the natural history of deformity progression, although new therapies including tumor necrosis factor-alpha inhibition have improved symptoms and pain (1). Spinal deformity in AS most commonly affects the thoracolumbar spine with flattening of lumbar lordosis and kyphosis across the mobile thoracolumbar junction. Cervical and upper thoracic deformity is present in 30% of cases, and involvement of these regions is more common in women (3). In the absence of a reliable medical intervention for the management of progressive spinal deformity in AS, surgical care remains an important consideration for the cohort of patients with AS and disabling spinal deformity. The purpose of this article is to review the surgical care of kyphotic deformity at the thoracolumbar spine using the closing wedge osteotomy.
