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Cervicothoracic Extension Osteotomy for Chin-on-Chest Deformity in Ankylosing Spondylitis
Theodore A. Belanger, MD1; R. Alden MilamIV, MD2; Jeffrey S. Roh, MD3; Henry H. Bohlman, MD3
1 Miller Orthopaedic Clinic, 1001 Blythe Boulevard, Suite 200, Charlotte, NC 28203. E-mail address: ted.belanger@millerclinic.com
2 Charlotte Spine Center, Charlotte Orthopedic Specialists, 2001 Randolph Road, Charlotte, NC 28207
3 University Hospitals Spine Institute and the Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at University Hospitals Spine Institute, Case Western Reserve School of Medicine, Cleveland, Ohio

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Aug 01;87(8):1732-1738. doi: 10.2106/JBJS.C.01472
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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 ten months).

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.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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