Clinical Outcome Results of Pedicle Subtraction Osteotomy in Ankylosing Spondylitis With Kyphotic Deformity

Kim, Ki-Tack; Suk, Kyung Soo; Cho, Yoon-Je; Hong, Gyu-Pyo; Park, Byung Joo

doi:10.1097/00007632-200203150-00010

Cited by 182 publications

(103 citation statements)

References 14 publications

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“…Postoperative blindness has been reported due to the -40 50 28 -4 32 2 40 20 20 108 a 16 a 92 a 3 12 -50 62 60 10 50 4 30 -18 48 16 0 16 5 10 -50 60 56 18 38 6 10 -50 60 34 -7 41 7 10 -50 60 40 12 28 8 26 -34 60 51 13 38 a Includes correction achieved due to staged thoracic, lumbar and cervical osteotomy during the same admission CBVA Chin brow vertical angle increased eyeball pressure during the operation [3]. Application of a halo preoperatively helps to: (1) immobilise the head with a Douro attachment to the table, thus avoiding the use of facial padding thereby reducing eyeball pressure and the incidence of postoperative facial oedema, (2) controlled correction of the deformity after the osteotomy, and (3) postoperative immobilisation in a halo jacket.…”

Section: Discussionmentioning

confidence: 99%

C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis

et al. 2007

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Our objective is to report on the clinical and radiological outcome following a decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis in patients with ankylosing spondylitis. The only treatment available for severe fixed flexion deformity of the cervical spine in these patients is an extension osteotomy. Traditionally an anterior opening, posterior closing wedge osteotomy is performed with or without internal fixation. We describe a decancellisation closing wedge osteotomy of C7 accompanied by secure segmental internal fixation. Eight patients operated between 1990 and 2003 with mean age of 54 years and minimum follow up of 2 years were retrospectively evaluated. Restoration of normal forward gaze was achieved in all patients. No patient suffered spinal cord injury or permanent nerve root palsy. There was no loss of correction or pseudarthrosis at final follow up. C7 decancellisation closing wedge osteotomy supplemented with secure segmental internal fixation in experienced hands provides a safe and effective treatment for fixed cervico-thoracic kyphosis in patients with ankylosing spondylitis.

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Section: Discussionmentioning

confidence: 99%

C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis

et al. 2007

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“…The position of C7 characterized by the C7 tilt was largely anterior before surgery (72°for a normal at 95°) and better positioned after (83°). The goals of surgical correction of sagittal malalignment in ankylosing spondylitis are to decrease the cosmetic and functional effects of the deformity, reduce the patient's pain, and increase their ability to stand and walk comfortably [4,7,16,17]. A number of techniques for inducing a posterior tilt to the spine and returning the gaze to the horizontal have been described [3,11,[17][18][19][20].…”

Section: Effect Of Lumbar Osteotomy For Kyphosis Correctionmentioning

confidence: 99%

Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy

Debarge¹,

Demey²,

Roussouly³

2009

Eur Spine J

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This is a radiographic study of ankylosing spondylitis patients with severe fixed kyphotic deformity who underwent pedicle subtraction osteotomy. Our goal was to measure and validate new angle to assess global kyphosis and to evaluate the radiological outcomes after surgery. This is the first report which describes new angle to assess global kyphosis (T1-S1). Pre and postoperative controls were compared according to the Pelvic Incidence. The sagittal parameters ankylosing spondylitis patients were compared with 154 asymptomatic patients. In addition to the pelvic parameters and the C7 tilt, we used the spino-sacral angle. Pelvic incidence in ankylosing spondylitis patients was higher than asymptomatic population (61 vs. 51°). For a same tilt of C7 for both groups, the low pelvic incidence group had a lower sacral slope and pelvic tilt and a higher global kyphosis (spino-sacral angle = 90°) than the high pelvic incidence group (spino-sacral angle = 98°). In the adult volunteers, the C7 tilt and spinosacral angle measured, respectively, 95 and 135°. The preoperative C7 tilt measured 73°and increased to 83°( p = 0.0025). The preoperative spino-sacral angle measured 96°and increased to 113.3°(p = 0.003). A low pelvic incidence pelvis has a lower sacral slope than in high pelvic incidence and can support a bigger kyphosis. All the parameters were improved by the pedicle subtraction osteotomy, but the average spino-sacral angle remained lower than the control group. When C7 tilt was useful to assess the improvement of the balance, SSA allowed a better evaluation of the correction of kyphosis itself.

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“…The degree of osteoporosis at the apical segments prevents satisfactory implant purchase and hence extension by a few segments cranially is preferred. Fusion to the sacrum in AS can cause problems with sitting on the floor due to a short distal lever arm [36]. However, this does not appear to be a problem in the western culture.…”

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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Clinical Outcome Results of Pedicle Subtraction Osteotomy in Ankylosing Spondylitis With Kyphotic Deformity

Abstract: Most of the patients maintained good correction and had good clinical results. Based on the results of this study, pedicle subtraction extension osteotomy is effective for correction of kyphotic deformity in ankylosing spondylitis.

Cited by 182 publications

References 14 publications

C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis

C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis

Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy

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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