Male, 28 years old, with ankylosing spondylitis over 14 years. Progressive spinal kyphosis 12 years,stiffness of spine and left hip in three years. Only conservative treatment for ankylosing spondylitis has been applied. Difficulty in movement of left hip and spine for 12 years.

Physical Examination: The patient can walk with no aid. The neck is over extended backward. Severe thoraco-lumbar kyphosis can be observed. The thoraco-lumbar spine is totally stiff. Slight tendness in bilateral hip, Range of motion of hips: Left hip can flex only 5 degrees and right hip can flex 60 degrees. Nervous system is normal with normal sensory, muscular strength, normal reflex, and negative pathological reflexes in bilateral lower extremities.

MRI: Spinal cord is without any pathologic findings. Lung pulmonary function test is normal. HLA-B27: Positive. ESR: 28 mm/hr (Normal value: 0-20 mm/hr), C-reactive protein: 23.6 mg/L (Normal value:0-5 mg/L).

Diagnosis:

1. Ankylosing Spondylitis
2. Severe Thoraco-Lumbar Kyphosis
3. Hip Arthritis with femoral head necrosis

Purpose of discussion: The patient wants his kyphosis be corrected for a better quality of life. Can the surgery be done or not? And if it can be done, how is the protocols?

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