What is the optimal postoperative sagittal alignment in ankylosing spondylitis patients with thoracolumbar kyphosis following one-level pedicle subtraction osteotomy?

Huang, Jiannan; Qian, Bangping; Qiu, Yong; Wang, Bin; Yu, Yang; Qiao, Mu

doi:10.1016/j.spinee.2019.11.005

Cited by 23 publications

(25 citation statements)

References 33 publications

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“…Osteotomy is an effective method to correct kyphosis and restore the sagittal alignment in patients with AS, which greatly improves their daily living activities and quality of life [5,9,12,15]. However, clinically, not all patients with kyphosis who undergo osteotomy can achieve a satisfactory sagittal balance at the follow-up, leading to an increased risk of implant failure, delayed union, pseudoarthrosis, and correction loss [8,16].…”

Section: Discussionmentioning

confidence: 99%

“…However, clinically, not all patients with kyphosis who undergo osteotomy can achieve a satisfactory sagittal balance at the follow-up, leading to an increased risk of implant failure, delayed union, pseudoarthrosis, and correction loss [8,16]. Until now, few studies have attempted to speci cally determine the preoperative predictions with clear threshold values to predict sagittal imbalance in patients with AS, and the optimal postoperative goal for preventing sagittal imbalance in these patients is still less known [9,12,13].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with unbalanced sagittal realignment might have a poor clinical outcome, which increases the risk of pseudoarthrosis, delay union, and instrumental failure, and may even require a second surgery [9,10]. Thus, it is necessary to nd preoperative predictions to predict sagittal imbalance in advance, and then, to determine the optimal postoperative goal for sagittal alignment construction [11,12], so as to decrease the rate of sagittal imbalance in patients with AS at the follow-up. However, preoperative predictions with clear threshold values and the optimal postoperative alignment in kyphosis secondary to AS following one-level three-column osteotomy have not been well documented yet.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative prediction of sagittal imbalance in kyphosis secondary to ankylosing spondylitis after one-level three-column osteotomy

Luo

Yang

et al. 2022

Preprint

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Background: This study aimed to determine preoperative predictions of sagittal imbalance in kyphosis secondary to ankylosing spondylitis (AS) after one-level three-column osteotomy. Methods: A total of 55 patients with AS who underwent one-level three-column osteotomy were enrolled. The patients were divided into two groups according to sagittal vertical axis (SVA) value at the final follow-up (group A: SVA>5 cm; group B: SVA≤5 cm). The radiographic measurements were measured, including global kyphosis, lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), sacral slope, T1 pelvic angle (TPA), SVA, osteotomized vertebral angle and PI and LL mismatch (PI-LL). Results: Fifty-five AS patients were followed up for 30.6 ± 10.2 months averagely (range, 24–84 months). Preoperatively and postoperatively, group A had larger LL, PT, PI - LL, TPA, and SVA values than group B (P<0.05). And the preoperative LL, PT, PI - LL, TPA, and SVA values had significantly positive relationships with the follow-up SVA value (P<0.05). The preoperative TPA>40.9°, PI-LL>32.5°, and SVA>13.7 cm were the top three predictions with the best accuracy to predict sagittal imbalance. The construction of postoperative SVA<7.4 cm was the key factor for decreasing the chance of sagittal imbalance on follow-up. Conclusions: The preoperative TPA>40.9°, PI - LL>32.5°, and SVA>13.7 cm could predict sagittal imbalance for AS kyphosis after one-level three-column osteotomy, and additional osteotomies were recommended for this condition. The postoperative SVA<7.4 cm was an optimal alignment for preventing sagittal imbalance. Level of evidence: IV

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preoperative prediction of sagittal imbalance in kyphosis secondary to ankylosing spondylitis after one-level three-column osteotomy

Luo

Yang

et al. 2022

Preprint

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“…All radiographic measurements were performed on standing fulllength spine lateral radiographs by an independent spine surgeon, which included: (1) global kyphosis (GK): de ned as the angle between the maximally tilted upper and lower endplate of vertebral; (2) thoracic kyphosis (TK): the angle between the superior endplate of T5 and the inferior endplate of T12; (3) lumbar lordosis(LL): the angle between the superior endplate of T12 and S1; a positive value of the aforementioned angle indicated kyphosis ;(4) sagittal vertical axis (SVA): de ned as the distance between the C7 plumb line and the posterosuperior corner of S1, if the C7 plumb line was anterior to the posterosuperior corner of S1, the value was positive. [15] In the rst-stage, 22 patients underwent a single-level Ponte osteotomy in the lateral position. The correction results of the rst-stage surgery were evaluated by the osteotomized vertebra intervertebral angle (OVI), a positive value indicated kyphosis.…”

Section: Radiographic and Clinical Assessmentmentioning

confidence: 99%

Treatment of Severe Kyphotic Deformity Secondary to Ankylosing Spondylitis by Staged Osteotomy in Lateral Decubitus Position: A Retrospective Study

Zhong¹,

Hu²,

Zhao³

et al. 2021

Preprint

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Background: Patients are often complicated with severe kyphotic deformity (Cobb>100 °) in the advanced stage of ankylosing spondylitis (AS). Corrective osteotomy based on prone position seems to be the only effective treatment. Sometimes, it is difficult to place AS patients with severe kyphosis in a prone position even with a specially prepared folding bed.Methods: 23 patients who underwent staged osteotomy in lateral position from October 2015 to June 2017 were analyzed. All but one patient underwent a single-level Ponte osteotomy in the first stage surgery; pedicle subtraction osteotomy was then carried out in the second stage surgery. The average follow-up was 30.8±4.6 months. The global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), the sagittal vertical axis (SVA), the osteotomized vertebra intervertebral angle (OVI), Chin-brow vertical angle (CBVA), the Oswestry Disability Index (ODI) score and the Scoliosis Research Society-22 Patient Questionnaire (SRS-22), were compared pre-and post-operation.Results：All kyphosis parameters were significantly improved (all P< 0.05). The GK was corrected from 115.0± 13.4 ° to 46.5 ± 9.0 ° postoperatively, with a mean correction of 68.5 °. The SVA was improved from 21.2 ± 5.1 cm to 5.1 ± 1.8 cm postoperatively. The CBVA was corrected from 64.1±23.2 ° to 5.7±10.6 ° postoperatively; The OVI was corrected from 9.0±2.7 ° to -20.1±5.6 ° postoperatively. There were significant improvements in the ODI and SRS-22 (all P< 0.05). 4 mild complications were observed perioperatively.Conclusion：Satisfactory correction is safely achieved by staged osteotomy in lateral decubitus position in AS patients with severe kyphosis, which can not only correct the sagittal imbalance of the spine with acceptable complications but also facilitate the placement of intraoperative position.

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“…Patients with unbalanced sagittal realignment might have a poor clinical outcome, which increases the risk of pseudoarthrosis, delay union, and instrumental failure, and may even enable a second surgery [ 9 , 10 ]. Thus, it is necessary to find preoperative predictions to predict sagittal imbalance in advance, and then, to determine the optimal postoperative goal for sagittal alignment construction [ 11 , 12 ], thereby reducing the incidence of sagittal imbalance in AS patients. However, preoperative predictions with defined threshold values and optimal postoperative alignment of kyphosis secondary to AS following one-level three-column osteotomy have not yet been well documented.…”

Section: Introductionmentioning

confidence: 99%

Preoperative prediction of sagittal imbalance in kyphosis secondary to ankylosing spondylitis after one-level three-column osteotomy

Luo

Yang

et al. 2022

BMC Musculoskelet Disord

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Background This study aimed to determine preoperative predictors for sagittal imbalance in kyphosis secondary to ankylosing spondylitis (AS) after one-level three-column osteotomy. Methods A total of 55 patients with AS who underwent one-level three-column osteotomy were enrolled. The patients were divided into two groups according to sagittal vertical axis (SVA) value at the final follow-up (group A: SVA > 5 cm; group B: SVA ≤ 5 cm). The radiographic measures included global kyphosis, lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), sacral slope, T1 pelvic angle (TPA), SVA, osteotomized vertebral angle and PI and LL mismatch (PI − LL). Postoperative clinical outcomes were evaluated using Scoliosis Research Society-22 questionnaire (SRS-22) and Oswestry Disability Index (ODI). Results Fifty-five AS patients had an average follow-up of 30.6 ± 10.2 months (range 24–84 months). Group A had larger preoperative and postoperative LL, PT, PI − LL, TPA and SVA values compared with group B (P < 0.05), and no significant differences were found in ODI and SRS-22 scores between the two groups (P > 0.05). Preoperative LL, PT, PI − LL, TPA, and SVA values were positively correlated with the follow-up SVA value (P < 0.05). Among them, TPA > 40.9°, PI − LL > 32.5° and SVA > 13.7 cm were the top three predictors with the best accuracy to predict sagittal imbalance. Immediate postoperative SVA value of ≤ 7.4 cm was a key factor in reducing the risk of sagittal imbalance during follow-up. Conclusions Preoperative TPA > 40.9°, PI − LL > 32.5° and SVA > 13.7 cm could predict sagittal imbalance in AS kyphosis after one-level three-column osteotomy, and additional osteotomies were recommended for this condition. Immediate postoperative SVA ≤ 7.4 cm was an optimal indicator for preventing sagittal imbalance. Level of evidence IV.

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What is the optimal postoperative sagittal alignment in ankylosing spondylitis patients with thoracolumbar kyphosis following one-level pedicle subtraction osteotomy?

Cited by 23 publications

References 33 publications

Preoperative prediction of sagittal imbalance in kyphosis secondary to ankylosing spondylitis after one-level three-column osteotomy

Preoperative prediction of sagittal imbalance in kyphosis secondary to ankylosing spondylitis after one-level three-column osteotomy

Treatment of Severe Kyphotic Deformity Secondary to Ankylosing Spondylitis by Staged Osteotomy in Lateral Decubitus Position: A Retrospective Study

Preoperative prediction of sagittal imbalance in kyphosis secondary to ankylosing spondylitis after one-level three-column osteotomy

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