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Introduction: Ankylosing Spondylitis (AS) is a disabling, incurable, inflammatory condition of the axial skeleton. Management is largely pharmacological with analgesia, and immune-modulation. Here, we present a case where pedicle subtraction osteotomy surgery brought huge benefit to a patient with severely disabling and refractory AS. However, currently only a minority of patients undergo surgery for disability from flexion deformity. We argue that spinal surgery should be used more often. Case: A 58 year old male presented with a five year history of worsening cervical pain and pronounced cervicothoracic kyphosis secondary to AS. He had been unresponsive to the third-line drug (Adalimumab) and his increasing deformity was preventing normal horizontal gaze. Pedicle subtraction osteotomy at C7, with posterior instrumentation from C2 to T5, restored more than 50 degrees of deformity, as well as both sagittal balance and horizontal gaze.
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