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BackgroundAnkylosing spondylitis is an autoimmune disease involving the axial bone. Because it leads to rigidity of the spine and joints, especially when involving the cervical spine, it will cause a difficult airway, creating a major challenge for airway management. Herein, we report presents a double visual intubation strategy for severe ankylosing spondylitis patients who are difficult to intubate with a video laryngoscope.Case PresentationA 31-year-old patient with severe ankylosing spondylitis has a seriously restricted neck movement that makes it hard to insert a tracheal tube using only a video laryngoscope. With the aid of video laryngoscope, we then guided the endotracheal intubation using a lighted stylet. Eventually, the oropharynx was opened sufficiently so that the tracheal tube could be rapidly introduced below the epiglottis and entered the glottis.ConclusionIn conclusion, the video laryngoscope is a viable operation to assist lighted stylet guided endotracheal intubation in severe ankylosing spondylitis patients after video laryngoscope intubation failure.