Abstract: Background Vertebral Column Decortication (VCD) osteotomy has gradually been adopted for the correction of kyphosis in ankylosing spondylitis (AS), yet its application in cervical-thoracic kyphosis is rarely reported. Objective To investigate the efficacy of VCD osteotomy in patients with cervical-thoracic kyphosis secondary to ankylosing spondylitis. Methods The radiological data and clinical score scales of patients with cervical-thoracic kyphosis secondary to ankylosing spondylitis who underwent Vertebral Column Decortication (VCD) osteotomy in our hospital from January 2020 to June 2024 were retrospectively analyzed. All patients underwent full-length spine anteroposterior and lateral X-rays preoperatively, postoperatively, and at the final follow-up. Measurements included the cervical sagittal vertical axis (cSVA), cervical lordosis (CL) from C2 to C7, and chin-brow vertical angle (CBVA). Additionally, the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score for cervical spine, and Visual Analogue Scale (VAS) for pain were collected to assess the clinical outcomes preoperatively and at the final follow-up. Secondary data analysis was conducted to compare the radiological parameters with the surgical outcomes of similar cases reported in the literature.Results A total of 19 male patients with ankylosing spondylitis (AS), aged from 23 to 71 years with a mean age of (44.7 ± 12.4) years, were enrolled in the study. All patients underwent surgery without complications such as neurological or vascular injury, cerebrospinal fluid leakage, etc. The mean intraoperative blood loss, surgical duration, and hospital stay were (1 178.9 ± 252.9) mL, (271.9 ± 54.0) min, and (16.3 ± 7.6) d, respectively. The mean osteotomy angle was (55.89 ± 10.16)°. The mean C2-7 cervical lordosis (CL) significantly improved postoperatively compared to preoperative values (27.21 ± 10.25° vs -25.37 ± 6.89°, P＜0.001), with a mean correction of (52.58 ± 6.90)°. The C2-C7 sagittal vertical axis (SVA) also showed significant improvement postoperatively (102.02 ± 21.16 mm vs 38.28 ± 14.31 mm, P＜0.001), with a mean correction of (63.73 ± 22.13) mm. The chin-brow vertical angle (CBVA) demonstrated marked improvement postoperatively (86.20 ± 15.20° vs 18.11 ± 4.44°, P＜0.001), with a mean correction of (68.09 ± 16.08)°. All patients were followed up, and compared with preoperative scores, the postoperative NDI, JOA and VAS scores of patients were improved (P< 0.05). Conclusion The application of VCD osteotomy in patients with cervical-thoracic kyphosis secondary to ankylosing spondylitis significantly corrects cervical kyphosis and CBVA, which is safe and reliable.