Background
Spinal deformity represents one of the most challenging and complex domains in spinal surgery. Over recent decades, substantial progress has been achieved through advancements in internal fixation systems, osteotomy techniques, and navigation technologies, significantly extending the boundaries of spinal deformity management. In the current era, the rapid development of artificial intelligence (AI) holds great promise in further transforming the diagnosis and treatment of spinal deformities.
Objective
This study aims to present the staged surgical management of a rare and extreme case of "3-on" folded man, which is a spinal kyphosis deformity secondary to ankylosing spondylitis (AS), highlighting the current development in managing severe spinal deformities. Furthermore, the study discusses future perspectives on the integration of AI and robotics in spinal deformity correction.
Methodology
A 40-year-old male presented with a severe kyphosis deformity due to advanced AS. His face was on femur, chin on chest, and the sternum on the pubis. The entire spine and both hips were fused, and the patient exhibited severe osteoporosis. A four-stage surgical plan was implemented, consisting of bilateral femoral neck osteotomies, cervical osteotomy, thoracolumbar osteotomy, and bilateral total hip arthroplasty. The deformity was ultimately corrected, enabling the patient to stand and walk independently.
Results
The surgical strategy was meticulously designed based on cumulative experience and literature evidence. However, a misjudgment in the outcome of the first-stage procedure necessitated a cervical osteotomy in an abnormal position during the second stage. Additionally, postoperative hip mobility remained suboptimal. Looking forward, the establishment of comprehensive spinal deformity databases combined with deep learning algorithms and intelligent surgical planning systems may provide surgeons with more intuitive and evidence-based decision-making tools. The application of orthopedic robots and intelligent positioning/reduction platforms can further enhance the safety and accuracy of correction procedures. Moreover, emerging technologies such as osteotomy robots and virtual reality systems are expected to reduce the risks associated with complex osteotomies and deformity corrections.
Conclusion
The ongoing advancement of AI and robotic technologies is anticipated to significantly reduce the technical barriers to routine spinal deformity correction and expand the frontier of surgical capability. Nevertheless, the treatment of extremely severe spinal deformities remains highly individualized and continues to depend heavily on the surgical team's expertise and multidisciplinary collaboration.
