A rare case of severe deformity in a patient with ankylosing spondylitis

Introduction Ankylosing spondylitis (AS) is a chronic inflammatory disease with associated rigid spinal deformities and sagittal imbalance. The identity of the clinical case reported was characterized by AS combined with Andersson lesion, pronounced three-plane deformity and the need for multi-stage combined surgical treatment involving an original technique of external reduction. The objective was to demonstrate surgical treatment of a patient with severe spinal deformities due to ankylosing spondylitis complicated by Andersson lesion and severe sagittal imbalance. Material and methods The clinical case of a 53-year-old patient with severe kyphoscoliosis, chronic pain and horizontal gaze disorder is reported. Multicomponent surgical management included a Schwab type 6 osteotomy at the Th12–L1 level, spondylodesis via posterior and transpleural approaches, osteoplasty of post screw defects, placement of laminar hooks and reconstruction of the metal construct. Preoperative 3D planning and original methods of fixation and reduction of the spine were employed. Results With the implant instability developed after the primary operation, successive staged surgical interventions facilitated restoration of the axis and support of the spinal column. Reliable interbody spondylodesis with no signs of hardware instability and improvement in the patient's quality of life were observed at one-year follow-up. Conclusion The clinical case demonstrated the need for a comprehensive multi-stage approach to the treatment of an AS patient with severe spinal deformities complicated by Andersen lesion and severe sagittal imbalance. The staged treatment resulted in sustainable clinical and functional improvement with the emphasis on individualized planning and adapted surgical strategy if complications arise.