title: Surgical treatment of "chin-on-pubis" deformity in a patient with ankylosing spondylitis: a case report of consecutive cervical, thoracic, and lumbar corrective osteotomies.
abstract: METHODS
  A case report.
  
  
  OBJECTIVE
  To report the successful consecutive spinal osteotomies of multiple segments performed on a patient with extremely severe kyphotic deformity.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Ki-Tack
authors.initials: KT
authors.lastname: Kim
authors.forename: Sang-Hun
authors.initials: SH
authors.lastname: Lee
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Son
authors.forename: Yoon-Ho
authors.initials: YH
authors.lastname: Kwack
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Chun
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000203:Activities of Daily Living; D019644:Arthroplasty, Replacement, Hip; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D056888:Patient Positioning; D011187:Posture; D011859:Radiography; D020127:Recovery of Function; D012720:Severity of Illness Index; D013123:Spinal Fusion; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome