Spinal Pseudarthrosis in Advanced Ankylosing Spondylitis With Sagittal Plane Deformity

Abstract

SPO at the level of pseudarthrosis was a safe and effective technique to correct sagittal imbalance without vascular complication. Surgical repair of pseudarthrosis with AIF provided successful fusion and good clinical results. For patients with lumbar hypolordosis, additional PSO was effective in restoration of sagittal balance.

Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis

“…Persistent and abnormal motion at the stress fracture site makes spontaneous healing difficult, which leads to the formation of pseudarthrosis [20]. Pseudarthrosis may complicate with a progressive kyphotic deformity causing sagittal imbalance and considerable disturbances of posture [16,23].…”

“…Surgical treatment is mandatory for patients with ASrelated thoracolumbar pseudarthrosis, who present with painful thoracolumbar kyphosis, neurological deficits, and sagittal imbalance [16,23]. The goals of surgical treatment are to restore sagittal alignment, to correct the kyphotic deformity and to achieve solid fusion of pseudarthrosis [23].…”

“…However, there is controversy regarding the optimal surgical procedure. Some authors believe that anterior fusion allows direct access to the anterior lesion [11,16], whereas others consider that pseudarthrosis can be treated effectively by posterior, transpedicular wedge resection osteotomy at the level of pseudarthrosis and fixation without supplemental anterior fusion [4,23]. Most surgeons recommend combined anterior and posterior approach for the treatment of pseudarthrosis and kyphotic deformity [6,16].…”

Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis

“…Earlier studies have addressed postoperative changes of sagittal balance in AS [2,7,8,14,18,21], and several authors have investigated relationships between HRQOL instruments and radiographic measurements to define objective criteria for the surgical treatment of adult spinal deformities. However, relatively few studies have addressed relations between AS and specific radiologic pelvic parameters.…”

“…Some authors have evaluated radiological and clinical outcomes after surgery [2,8,14,18], but no relationships have been established between sagittal spinopelvic parameters and preoperative HRQOL in AS. We considered that a more comprehensive understanding of relationships between the lumbar spine and pelvis is needed in AS, because correlations between radiographic parameters of the pelvis and HRQOL in AS would be useful for decision-making and surgical planning in patients with spinal disorders.…”