{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:29:42Z","timestamp":1770114582971,"version":"3.49.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,1,6]]},"abstract":"\n BACKGROUND<\/jats:title>\n Kyphotic spinal deformity is a complication of ankylosing spondylitis (AS). In rare cases, particularly in obese patients, the deformity might extend to the cervicothoracic spine, resulting in a severe \u201cchin-on-abdomen\u201d deformity. This condition severely impairs quality of life by affecting gaze, swallowing, and causing chronic pain. While corrective surgery is often performed for lumbar and thoracic kyphosis, cases involving global kyphotic deformities are less common.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors present the case of a 66-year-old obese man with AS and a chin-on-abdomen deformity. Prone positioning for surgery was not feasible due to his body habitus. A three-stage corrective surgery was performed: a C7 extension osteotomy in a semisitting position, an L3 pedicle subtraction osteotomy in the lateral decubitus position, and a T11 vertebral column resection in the prone position. The first stage utilized a seldom-used, earlier osteotomy technique with modern instrumentation and neuromonitoring. Obesity again precluded prone positioning in the second stage, necessitating surgery in the lateral position. Postoperatively, the patient exhibited significant postural improvement, maintained over a 5-year follow-up period.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case underscores the importance of adaptable techniques and positioning strategies in correcting complex spinal deformities in obese patients with AS. Integrating traditional methods with modern technology is crucial for achieving successful outcomes.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24664<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24664","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T01:47:07Z","timestamp":1736128027000},"source":"Crossref","is-referenced-by-count":0,"title":["Surgical correction of a chin-on-abdomen deformity due to ankylosing spinal deformity and obesity: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Mohsen","family":"Rostami","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesus Roberto","family":"Varela","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mena G.","family":"Kerolus","sequence":"additional","affiliation":[{"name":"Atlanta Brain and Spine Care, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J.","family":"DeWald","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo B. V.","family":"Fontes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"9","key":"bib1","series-title":"Nat Clin Pract Rheumatol","first-page":"463","article-title":"What causes hyperkyphosis in patients with ankylosing spondylitis?","volume":"2","year":"2006","unstructured":"What causes hyperkyphosis in patients with ankylosing spondylitis? Nat Clin Pract Rheumatol. 2006;2(9):463-463."},{"issue":"8","key":"bib2","series-title":"J Bone Joint Surg Am","first-page":"1732","article-title":"Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis","volume":"87","author":"Belanger","year":"2005","unstructured":"Belanger TAMilam RARoh JSBohlman HH. Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis. J Bone Joint Surg Am. 2005;87(8):1732-1738."},{"issue":"21","key":"bib3","series-title":"Chin Med J (Engl)","first-page":"2644","article-title":"Surgical treatment of a cervical spine fracture in an ankylosing spondylitis patient with severe global spine kyphosis and chin-on-chest deformity","volume":"132","author":"Guo","year":"2019","unstructured":"Guo XHJi HQ. Surgical treatment of a cervical spine fracture in an ankylosing spondylitis patient with severe global spine kyphosis and chin-on-chest deformity. Chin Med J (Engl). 2019;132(21):2644-2646."},{"issue":"26","key":"bib4","series-title":"Spine (Phila Pa 1976)","first-page":"2893","article-title":"Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity","volume":"34","author":"O\u2019Shaughnessy","year":"2009","unstructured":"O\u2019Shaughnessy BAKuklo TRHsieh PCYang BPKoski TROndra SL. Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity. Spine (Phila Pa 1976). 2009;34(26):2893-2899."},{"issue":"1","key":"bib5","series-title":"Spine (Phila Pa 1976)","first-page":"101","article-title":"Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year","volume":"30","author":"Willems","year":"2005","unstructured":"Willems KFSlot GHAnderson PGPavlov PWde Kleuver M. Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year. Spine (Phila Pa 1976). 2005;30(1):101-107."},{"key":"bib6","series-title":"World Neurosurg","first-page":"176","article-title":"Comparison of one-level osteotomy and two-level osteotomy for thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis","volume":"173","author":"Li","year":"2023","unstructured":"Li SChen LYe F, et al. Comparison of one-level osteotomy and two-level osteotomy for thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis. World Neurosurg. 2023;173:176-187.e1."},{"issue":"11","key":"bib7","series-title":"J Neurosurg Case Lessons","first-page":"CASE23708","article-title":"Multiple three-column osteotomies successfully correcting cervicothoracic kyphosis in the setting of ankylosing spondylitis: illustrative case","volume":"7","author":"Mugge","year":"2024","unstructured":"Mugge LGorka PBrewer CMcHugh B. Multiple three-column osteotomies successfully correcting cervicothoracic kyphosis in the setting of ankylosing spondylitis: illustrative case. J Neurosurg Case Lessons. 2024;7(11):CASE23708."},{"issue":"16","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"E1017","article-title":"Surgical treatment of \u201cchin-on-pubis\u201d deformity in a patient with ankylosing spondylitis: a case report of consecutive cervical, thoracic, and lumbar corrective osteotomies","volume":"37","author":"Kim","year":"2012","unstructured":"Kim KTLee SHSon ESKwack YHChun YSLee JH. Surgical treatment of \u201cchin-on-pubis\u201d deformity in a patient with ankylosing spondylitis: a case report of consecutive cervical, thoracic, and lumbar corrective osteotomies. Spine (Phila Pa 1976). 2012;37(16):E1017-E1021."},{"key":"bib9","series-title":"Clin Orthop Relat Res","first-page":"132","article-title":"The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis","volume":"86","author":"Simmons","year":"1972","unstructured":"Simmons EH. The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis. Clin Orthop Relat Res. 1972;86:132-143."},{"issue":"4","key":"bib10","series-title":"J Bone Joint Surg Am","first-page":"833","article-title":"Osteotomy of the cervical spine: report of a case of ankylosing rheumatoid spondylitis","volume":"40","author":"Urist","year":"1958","unstructured":"Urist MR. Osteotomy of the cervical spine: report of a case of ankylosing rheumatoid spondylitis. J Bone Joint Surg Am. 1958;40-A(4):833-843."},{"issue":"3","key":"bib11","series-title":"Semin Spine Surg","first-page":"188","article-title":"Osteotomies for the treatment of cervical kyphosis caused by ankylosing spondylitis: indications and techniques","volume":"23","author":"Wollowick","year":"2011","unstructured":"Wollowick ALKelly MPRiew KD. Osteotomies for the treatment of cervical kyphosis caused by ankylosing spondylitis: indications and techniques. Semin Spine Surg. 2011;23(3):188-198."},{"issue":"9","key":"bib12","series-title":"Spine (Phila Pa 1976)","first-page":"1068","article-title":"Flexion osteotomy of the cervical spine: a new technique for correction of iatrogenic extension deformity in ankylosing spondylitis","volume":"26","author":"Sengupta","year":"2001","unstructured":"Sengupta DKKhazim RGrevitt MPWebb JK. Flexion osteotomy of the cervical spine: a new technique for correction of iatrogenic extension deformity in ankylosing spondylitis. Spine (Phila Pa 1976). 2001;26(9):1068-1072."},{"issue":"1","key":"bib13","series-title":"Oper Neurosurg (Hagerstown)","first-page":"e72","article-title":"Two-level pedicle subtraction osteotomy in lateral position for an ankylosing spondylitis patient with severe thoracolumbar kyphosis and hip flexion contracture: a case report","volume":"23","author":"Ma","year":"2022","unstructured":"Ma SZhou ZYu HWu CDeng WCao K. Two-level pedicle subtraction osteotomy in lateral position for an ankylosing spondylitis patient with severe thoracolumbar kyphosis and hip flexion contracture: a case report. Oper Neurosurg (Hagerstown). 2022;23(1):e72-e76."},{"issue":"8","key":"bib14","series-title":"Orthop Surg","first-page":"2396","article-title":"Pedicle subtraction osteotomy in lateral position: a new strategy for correcting severe thoracolumbar kyphosis combined with hip flexion contracture in ankylosing spondylitis","volume":"13","author":"Song","year":"2021","unstructured":"Song DYZhang ZFWang THQi DBWang YZheng GQ. Pedicle subtraction osteotomy in lateral position: a new strategy for correcting severe thoracolumbar kyphosis combined with hip flexion contracture in ankylosing spondylitis. Orthop Surg. 2021;13(8):2396-2404."},{"issue":"9","key":"bib1","series-title":"Nat Clin Pract Rheumatol","first-page":"463","article-title":"What causes hyperkyphosis in patients with ankylosing spondylitis?","volume":"2","year":"2006","unstructured":"What causes hyperkyphosis in patients with ankylosing spondylitis? Nat Clin Pract Rheumatol. 2006;2(9):463-463."},{"issue":"8","key":"bib2","series-title":"J Bone Joint Surg Am","first-page":"1732","article-title":"Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis","volume":"87","author":"Belanger","year":"2005","unstructured":"Belanger TAMilam RARoh JSBohlman HH. Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis. J Bone Joint Surg Am. 2005;87(8):1732-1738."},{"issue":"21","key":"bib3","series-title":"Chin Med J (Engl)","first-page":"2644","article-title":"Surgical treatment of a cervical spine fracture in an ankylosing spondylitis patient with severe global spine kyphosis and chin-on-chest deformity","volume":"132","author":"Guo","year":"2019","unstructured":"Guo XHJi HQ. Surgical treatment of a cervical spine fracture in an ankylosing spondylitis patient with severe global spine kyphosis and chin-on-chest deformity. Chin Med J (Engl). 2019;132(21):2644-2646."},{"issue":"26","key":"bib4","series-title":"Spine (Phila Pa 1976)","first-page":"2893","article-title":"Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity","volume":"34","author":"O\u2019Shaughnessy","year":"2009","unstructured":"O\u2019Shaughnessy BAKuklo TRHsieh PCYang BPKoski TROndra SL. Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity. Spine (Phila Pa 1976). 2009;34(26):2893-2899."},{"issue":"1","key":"bib5","series-title":"Spine (Phila Pa 1976)","first-page":"101","article-title":"Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year","volume":"30","author":"Willems","year":"2005","unstructured":"Willems KFSlot GHAnderson PGPavlov PWde Kleuver M. Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year. Spine (Phila Pa 1976). 2005;30(1):101-107."},{"key":"bib6","series-title":"World Neurosurg","first-page":"176","article-title":"Comparison of one-level osteotomy and two-level osteotomy for thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis","volume":"173","author":"Li","year":"2023","unstructured":"Li SChen LYe F, et al. Comparison of one-level osteotomy and two-level osteotomy for thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis. World Neurosurg. 2023;173:176-187.e1."},{"issue":"11","key":"bib7","series-title":"J Neurosurg Case Lessons","first-page":"CASE23708","article-title":"Multiple three-column osteotomies successfully correcting cervicothoracic kyphosis in the setting of ankylosing spondylitis: illustrative case","volume":"7","author":"Mugge","year":"2024","unstructured":"Mugge LGorka PBrewer CMcHugh B. Multiple three-column osteotomies successfully correcting cervicothoracic kyphosis in the setting of ankylosing spondylitis: illustrative case. J Neurosurg Case Lessons. 2024;7(11):CASE23708."},{"issue":"16","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"E1017","article-title":"Surgical treatment of \u201cchin-on-pubis\u201d deformity in a patient with ankylosing spondylitis: a case report of consecutive cervical, thoracic, and lumbar corrective osteotomies","volume":"37","author":"Kim","year":"2012","unstructured":"Kim KTLee SHSon ESKwack YHChun YSLee JH. Surgical treatment of \u201cchin-on-pubis\u201d deformity in a patient with ankylosing spondylitis: a case report of consecutive cervical, thoracic, and lumbar corrective osteotomies. Spine (Phila Pa 1976). 2012;37(16):E1017-E1021."},{"key":"bib9","series-title":"Clin Orthop Relat Res","first-page":"132","article-title":"The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis","volume":"86","author":"Simmons","year":"1972","unstructured":"Simmons EH. The surgical correction of flexion deformity of the cervical spine in ankylosing spondylitis. Clin Orthop Relat Res. 1972;86:132-143."},{"issue":"4","key":"bib10","series-title":"J Bone Joint Surg Am","first-page":"833","article-title":"Osteotomy of the cervical spine: report of a case of ankylosing rheumatoid spondylitis","volume":"40","author":"Urist","year":"1958","unstructured":"Urist MR. Osteotomy of the cervical spine: report of a case of ankylosing rheumatoid spondylitis. J Bone Joint Surg Am. 1958;40-A(4):833-843."},{"issue":"3","key":"bib11","series-title":"Semin Spine Surg","first-page":"188","article-title":"Osteotomies for the treatment of cervical kyphosis caused by ankylosing spondylitis: indications and techniques","volume":"23","author":"Wollowick","year":"2011","unstructured":"Wollowick ALKelly MPRiew KD. Osteotomies for the treatment of cervical kyphosis caused by ankylosing spondylitis: indications and techniques. Semin Spine Surg. 2011;23(3):188-198."},{"issue":"9","key":"bib12","series-title":"Spine (Phila Pa 1976)","first-page":"1068","article-title":"Flexion osteotomy of the cervical spine: a new technique for correction of iatrogenic extension deformity in ankylosing spondylitis","volume":"26","author":"Sengupta","year":"2001","unstructured":"Sengupta DKKhazim RGrevitt MPWebb JK. Flexion osteotomy of the cervical spine: a new technique for correction of iatrogenic extension deformity in ankylosing spondylitis. Spine (Phila Pa 1976). 2001;26(9):1068-1072."},{"issue":"1","key":"bib13","series-title":"Oper Neurosurg (Hagerstown)","first-page":"e72","article-title":"Two-level pedicle subtraction osteotomy in lateral position for an ankylosing spondylitis patient with severe thoracolumbar kyphosis and hip flexion contracture: a case report","volume":"23","author":"Ma","year":"2022","unstructured":"Ma SZhou ZYu HWu CDeng WCao K. Two-level pedicle subtraction osteotomy in lateral position for an ankylosing spondylitis patient with severe thoracolumbar kyphosis and hip flexion contracture: a case report. Oper Neurosurg (Hagerstown). 2022;23(1):e72-e76."},{"issue":"8","key":"bib14","series-title":"Orthop Surg","first-page":"2396","article-title":"Pedicle subtraction osteotomy in lateral position: a new strategy for correcting severe thoracolumbar kyphosis combined with hip flexion contracture in ankylosing spondylitis","volume":"13","author":"Song","year":"2021","unstructured":"Song DYZhang ZFWang THQi DBWang YZheng GQ. Pedicle subtraction osteotomy in lateral position: a new strategy for correcting severe thoracolumbar kyphosis combined with hip flexion contracture in ankylosing spondylitis. Orthop Surg. 2021;13(8):2396-2404."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/1\/article-CASE24664.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/1\/article-CASE24664.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/1\/article-CASE24664.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T23:36:22Z","timestamp":1770075382000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/1\/article-CASE24664.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":28,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/case24664","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,6]]}}}