Ankylosing spondylitis is an inflammatory rheumatic disease that is often 
associated with back pain and restricted spinal movement. In the later stages of 
the disease, complete ossification of the entire spine and severe deformity can 
occur, often resulting in a marked reduction in quality of life and an increased 
risk of loss of independence due to diminished visual field. Patients with 
ankylosing spondylitis are at greater risk of spinal fractures. These are 
generally complex fractures associated with high morbidity and mortality; in 
addition, neurological deficits are not unusual. Conventional radiological 
diagnosis is often insufficient to establish a diagnosis. Conservative treatment 
of fractures of the spine in this patient group is unsatisfactory. Surgical 
procedures, if necessary combined with decompression, are often the preferred 
treatment of choice in the fractured or malaligned ankylosed spine. Rebalancing 
of the sagittal profile with normalization of the visual axis and an improvement 
of quality of life is achieved through corrective osteotomies. Despite the high 
rate of complications, long-term results following spinal surgery in patients 
with ankylosing spondylitis are good. Minimally invasive surgery is appropriate 
for a further reduction in the complication rate. Meticulous preoperative 
planning is essential in the treatment of patients with ankylosing spondylitis.