How to Calculate the Exact Angle for Two-level Osteotomy in Ankylosing Spondylitis?

Zheng, Guoyan; Song, Kai; Yao, Ziming; Zhang, Yonggang; Tang, Xiangyu; Wang, Zheng; Mao, Keya; Geng, Changran; Wang, Yan

doi:10.1097/brs.0000000000001610

Cited by 12 publications

(11 citation statements)

References 23 publications

(24 reference statements)

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“…Several osteotomy techniques have been described to restore sagittal balance for AS kyphotic deformity. To treat severe kyphotic deformity with TLK combined with loss of lumbar lordosis, a two-level osteotomy should be applied [4]. In a previous study, Song and Zheng et al [7] chose hilus pulmonis as the center of gravity for AS TLK and put forward an accurate method for calculating the exact angle required for one-level spinal osteotomy.…”

Section: Discussionmentioning

confidence: 99%

“…Since Smith-Petersen [3] performed an opening wedge lumbar osteotomy for AS flexion deformity, more and more researches about osteotomy techniques were reported. The main purpose of corrective osteotomy is a good correction of sagittal balance, which is recommended in most of papers to be achieved by one or two-level osteotomy in the lumbar or lower thoracic spine [1–4].…”

Section: Introductionmentioning

confidence: 99%

“…In patients with cervical ankylosis, the CBVA should be taken into consideration [7]. Usually, it is well accepted to perform a less osteotomy angle to ensure the patient’s horizontal visual field [4, 7, 8]. As a consequence, the correction of sagittal balance is sacrificed to some extent.…”

Section: Introductionmentioning

confidence: 99%

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Staged cervical osteotomy:a new strategy for correcting ankylosing spondylitis thoracolumbar kyphotic deformity with fused cervical spine

et al. 2019

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Background In patients with cervical ankylosis, the chin-brow vertical angle (CBVA) should be taken into consideration. Usually, the correction of sagittal balance is sacrificed to ensure the patient has a horizontal visual field. To our knowledge, a staged osteotomy strategy for ankylosing spondylitis kyphotic deformity with an ankylosed cervical spine has not been reported before. The aim of this study was to describe a new surgical strategy with emphasis on sagittal balance and gaze angle in correction of kyphotic deformity with a rigid cervical spine in ankylosing spondylitis thoracolumbar kyphotic deformity. Methods A 36-year-old man has severe thoracolumbar kyphosis accompanied with cervical hyperlordosis caused by ankylosing spondylitis. A two-stage surgery planning was managed. For the first stage, an interrupted two-level osteotomy was performed at the thoracolumbar area. After surgery, sagittal imbalance was corrected but the CBVA was − 21.7°. Cervical osteotomy was performed for the second stage. A flexion osteotomy was performed at C7, using anterior-posterior-anterior approaches. Results Both sagittal imbalance and gaze angle of the patient were improved markedly. The osteotomy sites were documented fused. Complications were not observed during and after operation. Conclusions The aim of osteotomy for ankylosing spondylitis is to reestablish sagittal balance and improve forward gaze and the visual field. A staged cervical osteotomy is an alternative to reduce cervical lordosis to obtain a normal gaze angle. An anterior-posterior-anterior approach is recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Staged cervical osteotomy:a new strategy for correcting ankylosing spondylitis thoracolumbar kyphotic deformity with fused cervical spine

et al. 2019

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“…Radiographic assessment for sagittal balance was performed preoperatively and at 2 weeks postoperatively and the final follow-up by measuring the following parameters: global kyphosis (GK, T5-S1), [15] thoracic kyphosis (TK, T5-T12), [16] lumbar lordosis (LL, L1-S1), [3,15] sagittal vertical axis (SVA), [15] and local kyphosis (LK): [17] the cobb angle between the superior endplate of the vertebra one above the osteotomy site and the inferior endplate of the vertebra one below the osteotomy site. Data from the preoperative and 2-year postoperative clinical records were extracted, including the Visual Analog Scale (VAS) [18] for back pain, the chin-brow vertical angle (CBVA) for horizon, [14] and the Scoliosis Research Society-22 (SRS-22) for quality of life.…”

Section: Parameters Measurement and Extractionmentioning

confidence: 99%

Outcomes, Complications, and Technical Aspects of One-Level Vertebral Column Decancellation Osteotomy for Thoracolumbar Kyphosis in Ankylosing Spondylitis: Experience of 39 Patients with Minimum 2-Year Follow-Up

Xin¹,

Zheng²,

Feng³

et al. 2020

Preprint

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Objective To evaluate the safety and efficacy of one-level vertebral column decancellation (VCD) for the correction of thoracolumbar kyphosis in ankylosing spondylitis (AS) will beneficial for clarify the application of this procedure. Methods With a minimum 2-year follow-up, 39 AS patients with kyphotic deformity who underwent one-level VCD were retrospectively reviewed. The operation time, blood loss, and perioperative complications were investigated to evaluate the technical safety. Pre- and postoperative radiographic and clinical parameters were compared to evaluate the technical efficacy. Results All of the osteotomy sites were located between T12 and L3. With an average operation time of 257.8±49.9 minutes, the average blood loss was 596.1±218 ml. 4 patients (10.3%) experienced complications during the follow-up period, while no deaths or complete paralysis were occurred. With an average correction of 45.07±11.27° have obtained for one-level VCD, the radiographic parameters improved significantly from preoperative to postoperative, including global kyphosis (from 42.05±13.82° to 1.51±12.08°), local kyphosis (from 20.54±15.43° to -24.54±12.83°), lumbar lordosis (from -8.01±16.34° to -42.81±13.98°), and SVA (from 17.47±6.77 cm to 7.45±5.37). At final follow-up, the clinical results were significantly improved compared with the preoperative results, including VAS for back pain (from 6.82±0.91 to 0.15±0.37), CBVA (from 30.44±10.81° to 10.10±3.92°) and all items of SRS-22 questionnaire. Conclusion With an acceptable complication rate, one-level VCD is an effective technique which can provide an average correction of 45° for correcting kyphotic deformity caused by AS, and can achieve good results even for severe AS kyphosis with a necessary correction angular up to 60°.

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“…4-Stabsystemen über Seitkonnektoren empfohlen. Arbeiten hinsichtlich Planung und OP-Technik der zweifachen PSO sind publiziert [26,27], die Korrektur mit der zweifachen PSO zeigte eine signifikant bessere Korrekturrate mit einer durchschnittlichen Korrektur von 53,7° [28].…”

Section: Thorakolumbale Osteotomienunclassified

Aktuelle operative Therapiekonzepte zur Behandlung von Wirbelsäulendeformitäten bei Morbus Bechterew

et al. 2018

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ZusammenfassungDie Korrektur von Wirbelsäulendeformitäten beim M. Bechterew erfordert eine große operative Erfahrung. Ist die OP-Indikation bei Absenkung der Blickachse und damit verbundener Einschränkung der Lebensqualität recht klar zu stellen, so erfordert die OP-Planung eine sorgfältige Beurteilung der individuellen Anatomie und des sagittalen Profils. Durch die präoperative Analyse wird, neben dem notwendigen Korrekturausmaß, insbesondere die Lokalisation und die Art der Osteotomie festgelegt. Über die eigentliche Osteotomie hinaus ist die Technik der implantatgeführten Korrektur von entscheidender Bedeutung, um Komplikationen wie eine Translation zu vermeiden. Die vorliegende Übersichtsarbeit fasst das aktuelle Vorgehen von Planung und operativer Korrektur zusammen.

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How to Calculate the Exact Angle for Two-level Osteotomy in Ankylosing Spondylitis?

Abstract: 4.

Cited by 12 publications

References 23 publications

Staged cervical osteotomy:a new strategy for correcting ankylosing spondylitis thoracolumbar kyphotic deformity with fused cervical spine

Staged cervical osteotomy:a new strategy for correcting ankylosing spondylitis thoracolumbar kyphotic deformity with fused cervical spine

Outcomes, Complications, and Technical Aspects of One-Level Vertebral Column Decancellation Osteotomy for Thoracolumbar Kyphosis in Ankylosing Spondylitis: Experience of 39 Patients with Minimum 2-Year Follow-Up

Aktuelle operative Therapiekonzepte zur Behandlung von Wirbelsäulendeformitäten bei Morbus Bechterew

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