Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 5 2025 04 26 237 241 Arash Heroabadi Brain and Spinal Cord Injury Research Center, NeurosciencesInstitute, Tehran University of Medical Sciences, Tehran, Iran. Reza Atef Yekta Pain Research Center, NeurosciencesInstitute, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Iman Asdaghi Jahromi Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Keihan Shabankhani Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 2025 02 20 2025 03 03 Ankylosing spondylitis (AS) is a progressive inflammatory disease characterized by spinal rigidity, kyphotic deformities, and significant challenges in airway management during surgery. We report the case of a 50-year-old male with severe kyphosis caused by long-standing AS, scheduled for corrective spinal surgery. Preoperative assessment revealed restricted cervical mobility, a “chin-on-chest” deformity, and a high risk of difficult intubation. Awake video-laryngoscopy-assisted intubation, combined with regional airway blocks, was successfully performed to minimize complications. Intraoperative neuromonitoring, strategic positioning, and meticulous hemodynamic management were implemented to ensure patient safety. The surgery was completedwithout neurological deficits, and the patient was discharged in stable condition. This case underscores the importance of thorough airway planning, neuromonitoring, and intraoperative vigilance in AS patients undergoing spinal correction. It highlights the critical role of a multidisciplinary approach in achieving successful surgical outcomes. https://crcp.tums.ac.ir/index.php/crcp/article/view/1027 https://crcp.tums.ac.ir/index.php/crcp/article/download/1027/692