Anaesthesia for cervical osteotomy.

CEnVlCAL OSTEOTOM~ for severe ankylosing spondylitis involving the cervical spine is uncommon. Yet, there are occasions when one may be called upon to provide anaesthesia for such an operation. At present there are no comprehensive reports on its anaesthetic management. The largest series of cervical osteotomy was reported by Simmons of Toronto, who at the time of his report had operated on 20 such cases. 1 Because of the diflqculties and complications associated with tracheal intubation, all cases had been done under local anaesthesia with supplementary neuroleptic agents or with nitrous oxide inhalation during the osteotomy itself? ,2,~ Ankylosing spondylitis often is complicated by very severe fixed flexion deformity of the cervical spine, total ankylosis of all vertebrae, and complete fixation of the chest cage. Because of the fixed flexion deformity of the cervical spine, tracheal intubation is the most difficult part in the anaesthestic management. Ankylosis of the entire spine is usually accompanied by fusion of the ribs to the vertebrae, which restricts the expansion of the chest cage. This results in a marked decrease in vital capacity and other respiratory volumes which may lead to respiratory insufficiency during and after anaesthesia. This presentation reports on the anaesthetic management for cervical osteotomy of two patients with severe fixed flexion deformity of the cervical spine.