Sayed Abdulla Jami, Zhanwen Zhou, Siam Al Mobarak, Mahzabin Tabassum, Fawad Ali

November 2021, Volume 30, Issue 11, pp 3415 - 3415 Original Article Read Full Article 10.1007/s00586-021-06913-1

First Online: 06 July 2021


The purpose of this case study and literature review is to describe the successful spinal osteotomy in the lateral position performed on ankylosing spondylitis (AS) patients with thoracolumbar kyphotic deformity combined with severe hip flexion contracture. The case study and literature review aim to determine alternative surgical methods for patients who are inoperable in the prone position.


A 33-year-old female AS patient with a prior total hip replacement (THR) is later diagnosed with severe thoracolumbar kyphosis and hip flexion ankylosis. The patient developed hip flexion contracture due to the excessive anteversion angle of the acetabular cup and poor rehabilitation from the THR. Due to the patient’s compounding medical conditions and THR, it was determined that she was inoperable in the prone position; therefore, the Smith–Petersen osteotomy (SPO) and pedicle subtraction osteotomy (PSO) at L3 was performed in the lateral position, not the prone position.


The patient's sagittal malalignment was significantly improved. Through the osteotomy segment, the correction angle was 60°. There were no intraoperative or postoperative complications. At six-month follow-up, the osteotomy site demonstrated complete fusion.


The PSO + SPO could be performed successfully in a lateral position. For those AS patients unable to be positioned prone due to coexisting severe thoracolumbar kyphosis and hip flexion contracture, performing spinal osteotomy in the lateral position as the first step is an alternative and gives comparable results to an operation performed in the prone position.

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