{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:59:33Z","timestamp":1790125173351,"version":"4.0.1"},"reference-count":15,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"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 Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,9,21]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Patients with ankylosing spondylitis (AS) often develop rigid chin-on-chest deformities that severely impair horizontal gaze and quality of life. Corrective strategies typically rely on high-morbidity posterior three-column osteotomies (3COs) or complex multistage \u201csandwich\u201d procedures. This report describes a simplified combined approach utilizing targeted anterior osteotomies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 50-year-old male with AS presented with severe chin-on-chest deformity, dysphagia, and inability to maintain horizontal gaze. The patient underwent a C3\u20137 anterior cervical discectomy and fusion where anterior osteotomies were achieved via bilateral uncinectomies and manual distraction with oversized interbody spacers. This was followed by a C2\u2013T2 posterior fusion with a C6\u20137 posterior column osteotomy. Postoperatively, the cervical sagittal vertical axis significantly improved, and horizontal gaze was fully restored. The patient was discharged on postoperative day 4 without neurological complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Strategic anterior osteotomies (uncinectomies and distraction) combined with a lower-grade posterior osteotomy can provide sufficient sagittal correction for chin-on-chest deformity in AS. This technique offers a potentially less morbid alternative to traditional 3COs in selected patients with AS.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26137\">https:\/\/thejns.org\/doi\/10.3171\/CASE26137<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26137","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:52Z","timestamp":1789516852000},"source":"Crossref","is-referenced-by-count":0,"title":["Combined anterior-posterior osteotomy technique for correction of chin-on-chest deformity in ankylosing spondylitis: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Anthony T.","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashel C.","family":"Dsouza","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5593-7376","authenticated-orcid":true,"given":"Nathan B.","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee A.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Neurosurg Focus","first-page":"E11","article-title":"A treatment algorithm for the management of cervical spine fractures and deformity in patients with ankylosing spondylitis","volume":"24","author":"Kanter","year":"2008","unstructured":"Kanter ASWang MYMummaneni PV.A treatment algorithm for the management of cervical spine fractures and deformity in patients with ankylosing spondylitis. 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J Neurosurg Spine. 2008;9(6):515-521. doi:10.3171\/SPI.2008.10.08226"},{"issue":"8","key":"bib5","series-title":"Eur Spine J","first-page":"1992","article-title":"Correction of dropped head deformity through combined anterior and posterior osteotomies to restore horizontal gaze and improve sagittal alignment","volume":"27","author":"Bronson","year":"2018","unstructured":"Bronson WHMoses MJProtopsaltis TS.Correction of dropped head deformity through combined anterior and posterior osteotomies to restore horizontal gaze and improve sagittal alignment. Eur Spine J. 2018;27(8):1992-1999. doi:10.1007\/s00586-017-5184-6"},{"issue":"2","key":"bib6","series-title":"Eur Spine J","first-page":"324","article-title":"Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project","volume":"28","author":"Koller","year":"2019","unstructured":"Koller HAmes CMehdian HCharacteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project. Eur Spine J. 2019;28(2):324-344. doi:10.1007\/s00586-018-5835-2"},{"issue":"3","key":"bib7","series-title":"J Neurosurg Spine","first-page":"269","article-title":"A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article","volume":"19","author":"Ames","year":"2013","unstructured":"Ames CPSmith JSScheer JKA standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article. J Neurosurg Spine. 2013;19(3):269-278. doi:10.3171\/2013.5.SPINE121067"},{"issue":"1","key":"bib8","series-title":"Neurosurgery","first-page":"112","article-title":"The comprehensive anatomical spinal osteotomy classification","volume":"74","author":"Schwab","year":"2014","unstructured":"Schwab FBlondel BChay EThe comprehensive anatomical spinal osteotomy classification. 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