Background: Chin-on-chest deformity is a disabling manifestation of
ankylosing spondylitis. Surgical treatment consists of extension osteotomy at
the cervicothoracic junction. The purpose of this study was to characterize
the clinical presentation of this deformity and to determine the long-term
functional and radiographic outcomes of treatment.
Methods: The medical records and radiographs of all twenty-six
patients treated with cervicothoracic extension osteotomy by one of us between
1976 and 2001 were retrospectively reviewed. Three patients died during the
two-year-minimum follow-up period. The remaining twenty-three patients were
followed for an average of 4.5 years (range, two years to twenty-one years and
Results: The mean sagittal correction was 38°. Delayed union in
two patients and additional cervical trauma in two others resulted in partial
loss of the initial correction. Quadriplegia developed in one patient, who
died as a result of subluxation at the osteotomy site. Five patients had
irritation of the eighth cervical nerve root postoperatively.
Conclusions: Extension osteotomy can reliably improve sagittal
alignment and horizontal gaze as well as decrease neck pain, eating
difficulties, and neurologic abnormalities. Internal fixation is recommended
to prevent subluxation, delayed union, nonunion, loss of correction, or
neurologic injury. There is a risk of death or catastrophic neurologic injury
from the procedure.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.