Technique, Dangers and Safeguards in Osteotomy of the Spine

Adams, John Crawford

doi:10.1302/0301-620x.34b2.226

Cited by 57 publications

(21 citation statements)

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“…We progressively tended towards closing osteotomies. The reasons are based on the vascular risks reported in the literature [1,3,6,19,20] (Fig. 6) and the instability caused by the anterior opening in the coronal and sagittal planes or in rotation [1,3,6,21,22].…”

Section: Closing Osteotomiesmentioning

confidence: 99%

“…The reasons are based on the vascular risks reported in the literature [1,3,6,19,20] (Fig. 6) and the instability caused by the anterior opening in the coronal and sagittal planes or in rotation [1,3,6,21,22]. Furthermore, the risk of stenosis has been reported in the literature [10,12,13,16,21,34,36] as has radicular compression or traction in major corrections.…”

Section: Closing Osteotomiesmentioning

confidence: 99%

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Surgery of the deformities in ankylosing spondylitis: Our experience of lumbar osteotomies in 31 patients

et al. 1997

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Section: Closing Osteotomiesmentioning

confidence: 99%

Section: Closing Osteotomiesmentioning

confidence: 99%

Surgery of the deformities in ankylosing spondylitis: Our experience of lumbar osteotomies in 31 patients

et al. 1997

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“…Over the years, several variations of this technique have been performed [10,11,15,17,18,[23][24][25]. However, elongation of the anterior column has been fraught with the risk of neurological and catastrophic vascular complications [11,15,[26][27][28].…”

Section: Discussionmentioning

confidence: 99%

“…Compression of the abdominal viscera by the inferior margins of the ribs and reduced diaphragmatic excursion further contributes to the morbidity experienced by these patients. The principles of correction of TLKD are essentially centred on lordosing osteotomies of the lumbar spine as thoracic deformity correction is limited by the ankylosed costovertebral joints [9][10][11][12][13][14]. The thoracic cord is less mobile and tolerant to handle in a relatively tight canal, thereby increasing the risk of neurological injury compared to the cauda equine in the capacious lumbar canal.…”

Section: Introductionmentioning

confidence: 99%

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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“…2,13,22,24,28,34,39,40,[43][44][45][50][51][52]60,61 Although extension osteotomy can correct the deformity, the technique does carry the risk of significant morbidity and mortality. By lengthening the anterior column, there is risk of injury to anterior vascular structures and neural elements.…”

Section: Extension (Smith-petersen) Osteotomymentioning

confidence: 99%

Management of iatrogenic flat-back syndrome

Wiggins¹,

Ondra²,

Shaffrey³

2003

FOC

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Iatrogenic loss of lordosis is now frequently recognized as a complication following placement of thoracolumbar instrumentation, especially with distraction instrumentation. Flat-back syndrome is characterized by forward inclination of the trunk, inability to stand upright, and back pain. Evaluation of the deformity should include a full-length lateral radiograph obtained with the patient's knees and hips fully extended. The most common cause of the deformity includes the use of distraction instrumentation in the lumbar spine and pseudarthrosis. Surgical treatment described in the literature includes opening (Smith-Petersen) osteotomy, polysegmental osteotomy, and closing wedge osteotomy. The authors will review the literature, cause, clinical presentation, prevention, and surgical management of flat-back syndrome.

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Technique, Dangers and Safeguards in Osteotomy of the Spine

Abstract: 1. The steps of the operation of spinal osteotomy, as carried out with the patient in the lateral posture, are described. 2. Details of post-operative management are given. 3. The major risks of the operation are discussed and precautions suggested.

Cited by 57 publications

References 0 publications

Surgery of the deformities in ankylosing spondylitis: Our experience of lumbar osteotomies in 31 patients

Surgery of the deformities in ankylosing spondylitis: Our experience of lumbar osteotomies in 31 patients

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

Management of iatrogenic flat-back syndrome

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