History of Spine Osteotomy

ObjectiveTo report the clinical results and surgical tactics of spinal osteotomy for ankylosing spondylitis (AS) kyphosis based on the experiences of 428 patients.MethodsFrom January 2003 to January 2015, a total of 428 patients suffering from AS kyphosis who underwent a one- or two-level pedicle subtraction osteotomy (PSO) or vertebral column decancellation (VCD) osteotomy in our hospital were reviewed. Pre- and postoperative radiological parameters and the chin-brow vertical angle (CBVA) were measured. Intraoperative, postoperative, and general complications were recorded.ResultsAll patients could walk with horizontal vision and lie on their backs postoperatively. The pre- and postoperative average global kyphosis (GK) angles were corrected from 82.6 to 12.7° (p = 0.000) in the two-level group and from 55.8 to 9.6° (p = 0.000) in the one-level group, respectively. The mean sagittal vertical axis (SVA) improved from 29.4 to 8 cm (p = 0.000) in the two-level group and from 18.0 to 4.3 cm (p = 0.000) in the one-level group. The CBVA improved from 68.3 to 8.2° (p = 0.000) in the two-level group and from 46.2 to 4.2° (p = 0.000) in the one-level group. Although no major acute complications such as death or complete paralysis occurred, the complication rate was 6.5% in the one-level group and 23.6% in the two-level group.ConclusionSpinal osteotomy, such as PSO and VCD, can improve the quality of life of AS patients as well as correct kyphotic deformities. The one-level spinal osteotomy showed a lower complication rate, while two-level spinal osteotomy was a relatively aggressive procedure that was more suitable in correcting severe AS kyphotic deformities.

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“…PSO, based on the method of Thomasen and Bridwell [16, 17], was performed in 138 patients. VCD (Figs.…”

Section: Methodsmentioning

confidence: 99%

Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients

et al. 2019

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“…Angular kyphotic deformities can be associated with a negative sagittal balance caused by compensatory hyperextension at the adjacent segments, which is also observed in our first case. [ 6 ] In all three cases, we used “sequential rod exchange technique” for kyphosis correction after VCR[ 12 ] and anterior column reconstruction with a mesh cage. On analyzing the cause for PJK, we retrospectively realized that, in our effort to limit the levels of instrumentation due to significant remnant growth potential, the UIV after the first surgery was away from C2 plumb line [Figures 2 and 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…The deformity was corrected by gradual shortening of the posterior column over the anterior cage (fulcrum) with sequential rod exchange technique. [ 12 ] The postoperative course was uneventful. Following surgery, the segmental kyphosis reduced to 34° and scoliotic Cobbs to 8° with good coronal/sagittal alignment [ Figure 2a and b ].…”

Section: Methodsmentioning

confidence: 99%

“…This was followed by hemivertebra excision, anterior column reconstruction using Harm's cage with gradual deformity correction using a sequential rod exchange technique. [ 12 ] The initial surgical plan was to instrument from D10 to L3 (three levels above and below the apex keeping in mind that the patient was Risser Grade 0). However, there was a screw pullout at L2, and hence the fixation was extended to L4.…”

Section: Methodsmentioning

confidence: 99%

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Proximal junctional kyphosis after pediatric angular kyphotic deformity correction: Are we missing something?

et al. 2021

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Purpose: Corrective maneuvers in an angular kyphotic deformity have its own problems including early complications such as neurological deficit and late complications such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). This article discusses the probable mechanisms, leading to PJK in pediatric severe angular kyphotic deformities and preventive strategies for the same. We will also assess natural course of untreated PJK and its devastating consequences. Materials and Methods: Three patients, two 13-year males presented with progressive, painless thoracolumbar kyphoscoliotic deformity, with segmental kyphosis 100° and 140° and scoliosis of 33° and 78°, respectively, and one 14-year-old female presented with angular kyphotic deformity of 60° with apex at D11-12 level. Results: Posterior vertebral column resection with segmental deformity correction with good coronal and sagittal balance was done. In the follow-up, PJF was seen. Second surgery was done with the extension of instrumentation to D4 along with deformity correction in both the male patients. The female patient did not opt for a revision surgery, and we are following the natural history of this case. Conclusion: In severe thoracolumbar angular kyphotic deformities with normal or negative sagittal balance, it might be a safer option to select the sagittal stable vertebra as upper instrumented vertebra based on the C2 plumb line on the preoperative standing lateral radiographs. However, a study with a larger sample size is needed to validate our hypothesis.

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“…(2) Second-stage PSO, based on the method of Wang [20], was performed two weeks after the rst-stage surgery. All but one patient underwent a second-stage procedure in the prone position.…”

Section: Radiographic and Clinical Assessmentmentioning

confidence: 99%

Treatment of Severe Kyphotic Deformity Secondary to Ankylosing Spondylitis by Staged Osteotomy in Lateral Decubitus Position: A Retrospective Study

Zhong¹,

Hu²,

Zhao³

et al. 2021

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Background: Patients are often complicated with severe kyphotic deformity (Cobb>100 °) in the advanced stage of ankylosing spondylitis (AS). Corrective osteotomy based on prone position seems to be the only effective treatment. Sometimes, it is difficult to place AS patients with severe kyphosis in a prone position even with a specially prepared folding bed.Methods: 23 patients who underwent staged osteotomy in lateral position from October 2015 to June 2017 were analyzed. All but one patient underwent a single-level Ponte osteotomy in the first stage surgery; pedicle subtraction osteotomy was then carried out in the second stage surgery. The average follow-up was 30.8±4.6 months. The global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), the sagittal vertical axis (SVA), the osteotomized vertebra intervertebral angle (OVI), Chin-brow vertical angle (CBVA), the Oswestry Disability Index (ODI) score and the Scoliosis Research Society-22 Patient Questionnaire (SRS-22), were compared pre-and post-operation.Results：All kyphosis parameters were significantly improved (all P< 0.05). The GK was corrected from 115.0± 13.4 ° to 46.5 ± 9.0 ° postoperatively, with a mean correction of 68.5 °. The SVA was improved from 21.2 ± 5.1 cm to 5.1 ± 1.8 cm postoperatively. The CBVA was corrected from 64.1±23.2 ° to 5.7±10.6 ° postoperatively; The OVI was corrected from 9.0±2.7 ° to -20.1±5.6 ° postoperatively. There were significant improvements in the ODI and SRS-22 (all P< 0.05). 4 mild complications were observed perioperatively.Conclusion：Satisfactory correction is safely achieved by staged osteotomy in lateral decubitus position in AS patients with severe kyphosis, which can not only correct the sagittal imbalance of the spine with acceptable complications but also facilitate the placement of intraoperative position.

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History of Spine Osteotomy

Cited by 5 publications

References 39 publications

Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients

Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients

Proximal junctional kyphosis after pediatric angular kyphotic deformity correction: Are we missing something?

Treatment of Severe Kyphotic Deformity Secondary to Ankylosing Spondylitis by Staged Osteotomy in Lateral Decubitus Position: A Retrospective Study

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