Transpedicular Wedge Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis

Abstract

Transpedicular wedge osteotomy can effectively and safely correct kyphotic deformity of the thoracolumbar spine caused by ankylosing spondylitis, regardless of rigidity of the spinal curves. Two-level osteotomy can provide sufficient correction for severe cases.

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

“…In this situation, an anterior strut graft can effectively reduce the stresses that act on the posterior instrumentation to prevent the above-mentioned complications. As reported by Chen et al [5], one patient of L3-4 spondylodiscitis in AS underwent PSO at L3 suffered from back pain, recurrence of kyphotic deformity and implant failure at 2 years follow-up. They deemed that the implant failure was attributable to the unhealed spondylodiscitis and the defect of the anterior column.…”

“…Third, the anterior and middle column at the segment of the bony defect will be functionally unstable; an iliac graft packed between the vertebral bodies can support the anterior and middle column structurally to restore the stability, and can achieve bony surfaces contact contributing to a rapid healing. Fourth, the presence of a gap in the anterior column may place excessive loads on the posterior instrumentation and compromise stability of the construct, which increases the incidence of late complications such as loss of correction or instrumentation failure [5,15]. In this situation, an anterior strut graft can effectively reduce the stresses that act on the posterior instrumentation to prevent the above-mentioned complications.…”

Management of iatrogenic flat-back syndrome

“…5,12,14,15,18,23,27,30,[35][36][37]46,47,55,68,69,73 In a recent report by Bridwell and associates 12 27 patients with fixed sagittal imbalance treated with pedicle subtraction closing wedge osteotomy were reviewed. The causes were varied (14 idiopathic scoliosis, eight degenerative scoliosis, three posttraumatic, and two ankylosing spondylitis).…”

Two-level pedicle subtraction osteotomy for severe thoracolumbar kyphotic deformity in ankylosing spondylitis

“…And PSO, a V-shaped wedge resection of the vertebral body, involving bilateral pedicles and posterior elements, was first introduced to correct AS kyphosis by Thomasen in 1985 [10]. This type of osteotomy, typically performed at L2 or L3, which is the normal apex of lumbar lordosis, can obtain a correction of 30-40°at one osteotomized segment [3][4][5][11][12][13][14]. While VCR is a formidable last resort technique reserved for the most tenacious spinal deformities which are not amenable to other osteotomy techniques such as the SPO or the PSO, it has been suggested for the treatment of spinal tumor, congenital kyphoscoliosis as well as for hemivertebrae excision [15].…”

“…Although VCR could obtain enough correction, it is not fully suitable for the treatment of global sagittal imbalance. Thus, some authors recommended two-level PSO to complement the correction insufficiency [5,11,12]. Yet still, these articles did not talk about surgical strategies of two-level PSO for severe AS kyphosis in detail.…”