Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity

Kim, Ki Tack; Park, Dae Hyun; Lee, Jun Young

doi:10.4055/cios.2015.7.3.330

Cited by 37 publications

(27 citation statements)

References 21 publications

(22 reference statements)

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“…In a recent study, Qian et al [ 3 ] demonstrated loss of correction of 3.6° and 2.5° in global kyphosis (GK) and LL after posterior wedge osteotomy with a mean follow-up of 3 years. Besides, Kim et al [ 7 ] reported loss of 4.8° in GK correction for AS-related kyphosis over 2 years postoperatively. In the presence of existing thoracic kyphosis, the loss of correction may place the fusion zone under tension due to the long lever arm, thereby resulting in the implant failure and progressive loss of correction [ 8 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

The patterns of loss of correction after posterior wedge osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis: a minimum of five-year follow-up

Qiao

Qian

Mao

et al. 2017

BMC Musculoskelet Disord

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BackgroundShort-term studies have demonstrated good surgical outcomes after pedicle subtraction osteotomy (PSO) in ankylosing spondylitis (AS) patients, but there is a paucity of literature focused on middle-term results, especially regarding patterns of loss of correction. The objective of this study is to assess the durability of surgical outcomes and the patterns of loss of correction in thoracolumbar kyphosis secondary to AS following lumbar PSO with over 5-year follow-up.MethodsWe performed a retrospective review of 155 consecutive AS patients undergoing lumbar PSO from January 2001 to December 2011. Twenty-four patients were included with an average follow-up of 6.9 years (range, 5–15 years). Radiographical evaluations included global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis, spinal-sacral angle, kyphosis of proximal non-fused segments (KPNS), angle of fused segments (AFS), osteotomized vertebra angle (OVA), distal intervertebral disc wedging (DIDW) and proximal junctional angle. Meanwhile, clinical outcomes were assessed by the Oswestry disability index (ODI) and Numerical rating scale (NRS).ResultsThe average correction per PSO segment was 34.9°. Significant improvement in sagittal parameters were found postoperatively, and no obvious deterioration was noticed during the follow-up. Mild loss of correction in GK (2.82°) and LL (3.77°) were observed at the final follow-up (P < 0.05). The KPNS and DIDW increased from 26° and −5.0° postoperatively to 30° and −2.2° at the final follow-up (P < 0.05), respectively. In contrast, no significant diminishment was identified in OVA and AFS (P > 0.05). The ODI and NRS improved significantly from 20.6 and 6.6 preoperatively to 5.9 and 2.3 at the final follow-up (P < 0.05).ConclusionsPSO is an effective procedure for treating AS-related thoracolumbar kyphosis and can maintain sustained surgical outcomes during the middle-term follow-up. The loss of correction was mainly attributable to non-instrumented segments without fully ossified bridging syndesmophyte in the thoracolumbar region instead of instrumented levels.

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Section: Introductionmentioning

confidence: 99%

The patterns of loss of correction after posterior wedge osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis: a minimum of five-year follow-up

Qiao

Qian

Mao

et al. 2017

BMC Musculoskelet Disord

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“…This was also observed in the retrospective study conducted by Lin et al, 20 to analyze the correlations of spinopelvic parameters with the clinical outcomes of AS patients after corrective surgery. On the contrary, Kim et al, 16 confirmed the relationship between SVA and postoperative ODI, however they denied any significant correlation between other spinopelvic parameters (PI, PT, LL and TK) and ODI.…”

Section: Clinical Outcomementioning

confidence: 92%

“…Classifications and management plans have been developed to address the spinal deformity in AS. 16,31 We believe that every patient should have its own custom made treatment plan taking in consideration several factors including: type and severity of deformity, site of maximum deformity, bone quality, amount of correction needed, general medical condition of the patient, hip condition and occupation of the patient. Variable methods have been described to estimate the correction required.…”

Section: Surgical Planningmentioning

confidence: 99%

A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis

Ibrahim¹,

El-Meshtawy²,

Shousha³

et al. 2018

Egyptian Spine Journal

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Background Data: Ankylosing spondylitis (AS) is a chronic inflammatory disease that can severely alter the normal spinal sagittal balance resulting in functional and social disability. Although the traditional open corrective techniques have provided a great radiographic improvement, they are associated with relatively high morbidity and mortality in an already vulnerable patient with several medical comorbidities. Therefore, a new less invasive technique has been developed in an attempt to achieve both radiographic and clinical improvement while minimizing the possible surgical risks of conventional open approaches. Purpose: To present an innovative less invasive technique for management of thoracic and/or lumbar sagittal imbalance in AS and to evaluate the morbidity, clinical results and radiographic correction following the use of this technique. Study design: Retrospective analysis of prospectively collected data. Methods: Between September 2008 and September 2013, 51 patients (43 males and 8 females) with thoracic and/or lumbar sagittal imbalance due to AS were operated upon. Those patients underwent minimally invasive dorso-ventral osteotomy and reconstruction plus posterior percutaneous instrumentation in the same prone position. Sagittal vertical axis (SVA), T1 pelvic angle (TPA), angle of fusion levels (AFL) and chin-brow vertical angle (CBVA) were used to evaluate radiographic outcomes and degree of correction. Clinical outcomes were assessed by Oswestry Disability Index (ODI) and visual analogue scale (VAS). Results: The mean age at operation was 49.02 years. The mean operative time was 419.31 min with a mean blood loss of 698.24 ml. One third of the patients underwent more than one single dorso-ventral osteotomy. All clinical and radiographic parameters (except for PI) showed a statistically significant improvement after surgery (P< 0.0001). The mean correction of AFL was 32.23±10.16° while the mean loss of correction was 2.00±2.89°. In the present study, not only the mean ODI improved significantly from 48.67±7.86 preoperatively to 19.25±10.22 at the latest follow up (P< 0.0001), but also 94% of the patients showed >30% improvement from the baseline ODI. Moreover, the changes in ODI were significantly related to

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“…The tactics of surgical treatment [14] was planned: in the first stage L3 PSO [15] (Pedicle Subtraction Osteotomy) with the maximum possible correction. The multi-level Smith-Petersen osteotomy was considered impossible [16] due to the complete ossification of both columns of the spine.…”

Section: Methodsmentioning

confidence: 99%

Multilevel spinal osteotomy in ankylosing spondylitis – case report

Niedźwiecki¹,

Makowski²,

Niedźwiecki³

et al. 2018

Chir. Narzadow Ruchu Ortop. Pol.

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Ankylosing spondylitis (AS, Bechterew's Disease) is a chronic inflammatory disease of the spine of unknown etiology. One of its consequences is the progressive deformity of the spine. The resulting spinal imbalance results in falls and fractures. Surgical treatment of fixed deformities consists in reconstructing the spine balance through osteotomies of the spine with its stiffening in a corrective position. The following paper presents the case of a patient with total hyperkyphosis in the course of AS, traumatic PTK, and global sagittal imbalance, subjected to two-stage surgical treatment of spinal deformities with the use of three-column osteotomies in the cervical and lumbar spine sections.

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Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity

Cited by 37 publications

References 21 publications

The patterns of loss of correction after posterior wedge osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis: a minimum of five-year follow-up

The patterns of loss of correction after posterior wedge osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis: a minimum of five-year follow-up

A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis

Multilevel spinal osteotomy in ankylosing spondylitis – case report

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