Polysegmental lumbar posterior wedge osteotomies for correction of kyphosis in ankylosing spondylitis

Royen, Barend J. van; Kleuver, Marinus de; G, Slot

doi:10.1007/s005860050039

Cited by 58 publications

(34 citation statements)

References 16 publications

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“…Two patients had transient neurological deficits and the overall complication rate is similar to that noted in previous reports [35,37]. One unfortunate patient had catastrophic blood loss during correction of OWO.…”

Section: Discussionsupporting

confidence: 84%

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Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction

2011

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Introduction The principles of correction of thoracolumbar kyphotic deformity (TKLD) in ankylosing spondylitis (AS) are essentially centred on lordosing osteotomies such as pedicle subtraction closing wedge osteotomy (CWO), polysegmental posterior lumbar wedge osteotomies (PWO) and Smith Peterson's open wedge osteotomy (OWO) of the lumbar spine. There have been no studies that compared the results of the three osteotomies performed by a single surgeon with a long-term follow-up. Materials and Methods A retrospective review of 31 patients with AS was performed: 12 patients underwent CWO, 10 had OWO, and 9 had PWO. Radiographic assessment was performed at 6, 12, 24, and 52 weeks and annually thereafter. Clinical assessment included blood loss, intensive care unit (ICU) stay, and surgical time recordings. All patients were assessed clinically at regular intervals and outcome measures recorded included Oswestry Disability Index (ODI), Visual Analogue Score (VAS) for pain, and SRS-22 (recorded in 23 patients).Results The mean age at surgery was 54.7 years (40-74 years) and mean duration of symptoms was 3 years (range, 5-8 years). Mean follow-up was 5 years (range, 2-10 years). There was no statistically significant difference between the three techniques with regard to mean duration of surgery and ICU stay. The mean duration of surgery was 7 h (range, 4-9 h) (OWO cases had shorter period than CWO and PWO cases, and the longest period was for CWO cases). The mean ICU stay was 3 days (range, 2-20 days) (the period of stay was shorter in general for OWO and slightly longer for CWO and PWO). Blood loss was expressed as percentage of estimated blood volume (EBV). The mean blood loss in PWO was 23 ± 15.4% (range, 9-36%), CWO was 28 ± 4.5% (range, 12-40%) and in OWO was 15 ± 11% (range, 13-99%). Mean correction of kyphosis was 38°(range, 25°-49°) with CWO, 28°with OWO (range, 24°-38°) and 30°with PWO (range, 28°-40°). In comparison to preoperative scores, statistically significant improvement was noted in all three groups in the postoperative period with regard to ODI, VAS and SRS-22 (p = 0.001, Wilcoxon signed-rank test). Conclusion Better radiographic correction was noted in the CWO and PWO groups, although this was associated with increased blood loss, multiple levels of instrumentation, and increased surgical time compared to OWO. A new safe technique of instrumentation using temporary malleable rods to prevent sagittal translation during the reduction manoeuvre is also described.

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Section: Discussionsupporting

confidence: 84%

“…Another study also showed that pedicle screw instrumentation in PWO yielded good results [35]. Initial cases in our series were performed using different forms of instrumentation [(5 Hook and rod, 4 Universal Spine Instrumentation Systems-pedicle screw with threaded rods (Ulrich, Ulm, Germany)].…”

Section: Discussionmentioning

confidence: 89%

Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction

2011

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“…Abnormalities of sagittal spinal balance are considered as an abnormal condition [1,[4][5][6][7][8]14]. In spinal sagittal plane deformities, such as flat back syndrome, lumbar kyphosis, or severe thoracic kyphosis, there is a positive sagittal balance with the SVA falling in front of the sacrum.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of the sagittal vertical axis in a standing lateral radiograph as a measurement of balance in spinal deformities

Royen

Toussaint

Kingma

et al. 1998

European Spine Journal

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129

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“…In contrast to the process in the SPO, elongation of the anterior column in the polysegmental posterior wedge osteotomy is done over multiple segments and without fracturing the anterior column. 58 Van Royen and colleagues 58 reported a mean correction of 9.5°per level (36.3°o verall) in 21 patients who had been treated using this osteotomy combined with instrumentation in the thoracolumbar or lumbar spine. At the last follow-up, however, there was a mean loss of 10.7°.…”

Section: Neurosurg Focus / Volume 24 / January 2008mentioning

confidence: 99%

Complications of the spine in ankylosing spondylitis with a focus on deformity correction

Mundwiler

Siddique

Dym

et al. 2008

FOC

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Polysegmental lumbar posterior wedge osteotomies for correction of kyphosis in ankylosing spondylitis

Cited by 58 publications

References 16 publications

Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction

Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction

Accuracy of the sagittal vertical axis in a standing lateral radiograph as a measurement of balance in spinal deformities

Complications of the spine in ankylosing spondylitis with a focus on deformity correction

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