Vascular Complications Associated with Osteotomy in Ankylosing Spondylitis: A Report of Two Cases

Weatherley, Cristopher; Jaffray, David; Terry, Arthur F.

doi:10.1097/00007632-198801000-00010

Cited by 81 publications

(25 citation statements)

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“…Many modifications of this procedure have been described [1-4, 10, 11, 13-15, 17-19, 21, 22, 25]. These anterior open-wedge osteotomies produce a sharp lordotic angle and elongation of the anterior column, and sometimes cause serious complications such as vascular and irreversible neurologic complications [3,12,15,16,23,25,27].…”

Section: Introductionmentioning

confidence: 99%

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

Royen

Kleuver

1998

European Spine Journal

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Section: Introductionmentioning

confidence: 99%

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

Royen

Kleuver

1998

European Spine Journal

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“…The correction angle can reach 20°-40°. Weatherley [7,8] reported that correction of 45° would result in extension of the anterior border of the spine up to 2 cm. Major vessels anterior to the vertebrae are usually more tightly adhered to them in traumatic fixed kyphotic deformity of the spine.…”

Section: Discussionmentioning

confidence: 99%

“…Nerve injury was reported up to 30% after vertebral osteotomy [7,8]. One cause of such damage was intraoperative direct injury.…”

Section: Discussionmentioning

confidence: 99%

Modified Decancellation Posterior Closing-Wedge Osteotomy for Correction of Traumatic Thoracolumbar Kyphotic Deformity: A Cadaveric and Preliminary Clinical Study

Sheng¹

2014

Int J Phys Med Rehabil

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Study design: Cadaveric and clinical studies. Objectives:To investigate the safety and efficiency of modified decancellation posterior closing-wedge osteotomy for traumatic fixed kyphotic deformity of thoracolumbar spine. Methods:Single-level vertebral osteotomy was performed on two groups of fresh-frozen human cadaveric lumbar spines. Group I underwent conventional decancellation posterior closing-wedge osteotomy, and Group II underwent our modified cancellation posterior closing-wedge osteotomy. Sagittal plane angulation as well as anterior height and distance between the most cephalad and caudal endplate were measured before and after osteotomy. Twenty six cases of old thoracolumbar fractures with spinal cord injury were recruited in this study. The mean age was 35.6 years. The mean time from injury to operation was 25 months ranging from 3 months to 11 years. Prior to the index surgery, 9 patients received conservative treatment, and 17 patients underwent surgical treatment. There was complete paraplegia in 10 cases and incomplete paraplegia in 14 (Frankel B in 2 cases, C 10 and D 2). Two patients had no neurological deficit. All patients suffered from low back pain, the average score of Visual Analog Scale (VAS) was 4.5 (range 2.5-6.0). The patients were found to have a mean remaining kyphotic deformity of 35° (range 20°-75°). According to the deformity angles conventional or modified decancellation posterior closing-wedge osteotomy was performed. Results:The mean correction was 36° ± 3.6° for Group I and 49° ± 2.0° for Group II. The mean change in anterior height was only 2-4 mm for Group I and II. All cases were followed up for 10 months to 6 years with a mean of 12.5 months. Successful decompression and satisfied correction of kyphosis was noticed. The post-operatively mean angle of kyphosis deformity was 10.8°, ranging from 0° to 40°. Neurological function recovery was noted in 50% of cases. For complete spinal cord injury, 30% of cases had partial recovery (sensation) whereas recovery was observed in 64.3% of cases with incomplete spinal cord injury. The statistical difference between the groups was p<0.01. The mean score of visual analog scale (VAS) was 2.3 (range 1.0-3.5) at last follow-up. Conclusion:The fixed kyphotic deformity of thoracolumbar spine in traumatic spinal cord injury could be treated with conventional or modified decancellation posterior closing-wedge osteotomy. Neurological function recovery and alleviation of low back pain is expected.

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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%

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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Vascular Complications Associated with Osteotomy in Ankylosing Spondylitis: A Report of Two Cases

Cited by 81 publications

References 0 publications

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

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

Modified Decancellation Posterior Closing-Wedge Osteotomy for Correction of Traumatic Thoracolumbar Kyphotic Deformity: A Cadaveric and Preliminary Clinical Study

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

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