Junctional Failure After Thoracolumbar Kyphosis Correction in Patients with Ankylosing Spondylitis

Kim, Ki Tack; Ha, Kee-Yong; Kim, Sang Il; Kim, Yong Chan; Kim, Young Hoon; Seo, Jeung Hwan

doi:10.1016/j.wneu.2021.01.134

Cited by 2 publications

(2 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, significant emphasis is warranted on the risk of PJK in patients performed 1-level PSO, and the risk of distal junctional kyphosis in AS patients undergone 3-level PSO. To reduce the risks, special attention should be paid on the selection of the osteotomy site and the lowest instrumented vertebra [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Multilevel Pedicle Subtraction Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Clinical Effect and Biomechanical Evaluation

Lv,

Nuertai,

Wang

et al. 2024

Neurospine

View full text Add to dashboard Cite

Objective: To compare the clinical outcomes and biomechanical characteristics of 1-, 2-, and 3-level pedicle subtraction osteotomy (PSO), and establish selection criteria based on preoperative radiographic parameters.Methods: Patients undergone PSO to treat ankylosing spondylitis from February 2009 to May 2019 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled. According to the quantity of osteotomy performed, the participants were divided into group A (1-level PSO, n = 24), group B (2-level PSO, n = 19), and group C (3-level PSO, n = 11). Clinical outcomes were assessed before surgery and at the final follow-up. Comparisons of the radiographic parameters and quality-of-life indicators were performed among and within these groups, and the selection criteria were established by regression. Finite element analysis was conducted to compare the biomechanical characteristics of the spine treated with different quantity of osteotomies under different working conditions.Results: Three-level PSO improved the sagittal parameters more significantly, but resulted in longer operative time and greater blood loss (p < 0.05). Greater stress was found in the proximal screws and proximal junction area of the vertebra in the model simulating 1-level PSO. Larger stress of screws and vertebra was observed at the distal end in the model simulating 3-level PSO.Conclusion: Multilevel PSO works better for larger deformity correction than single-level PSO by allowing greater sagittal parameter correction and obtaining a better distribution of stress in the hardware construct, although with longer operation time and greater blood loss. Three-level osteotomy is recommended for the patients with preoperative of global kyphosis > 85.95°, T1 pelvic angle > 62.3°, sagittal vertical alignment > 299.55 mm, and pelvic tilt+ chin-brow vertical angle > 109.6°.

show abstract

Section: Discussionmentioning

confidence: 99%

Multilevel Pedicle Subtraction Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Clinical Effect and Biomechanical Evaluation

Lv,

Nuertai,

Wang

et al. 2024

Neurospine

View full text Add to dashboard Cite

show abstract

“…Previous studies about thoracolumbar kyphosis have mainly focused on ankylosing spondylitis, Scheuermann's disease, and thoracolumbar fractures [11][12][13], as well as risk factors for proximal junctional kyphosis after long segment fixation surgery [14]. Gao et al [15] believed that the preoperative application of digital intelligent software Surgimap Spine contributed to the design and treatment of thoracolumbar kyphosis in ankylosing spondylitis patients, and the clinical efficacy was satisfactory.…”

Section: Thoracolumbar Junctional Kyphosismentioning

confidence: 99%

Thoracolumbar/Lumbar Degenerative Kyphosis—The Importance of Thoracolumbar Junction in Sagittal Alignment and Balance

Liu,

Ge,

et al. 2023

JPM

View full text Add to dashboard Cite

Purpose: To conduct a more comprehensive study of sagittal alignment in patients with thoracolumbar/lumbar (TL/L) degenerative kyphosis. Methods: A total of 133 consecutive patients from September 2016 to March 2019 with degenerative spinal kyphosis were enrolled. These patients were divided into different types according to sagittal alignment, including thoracolumbar junctional kyphosis (TLJK). Then, we divided the patients with TLJK into two groups: the Sagittal Balance group (C7-SVA < 50 mm) and the Sagittal Imbalance group (C7-SVA ≥ 50 mm). The sagittal parameters of each type or group were compared and correlation analysis was conducted. Results: Thoracolumbar/lumbar degenerative kyphosis consists of four types: Type I, lumbar kyphosis; Type II, degenerative flat back; Type III, thoracolumbar junctional kyphosis; and Type IV, global kyphosis. According to different sagittal alignments, Type III can further be divided into three subtypes: IIIA, with smooth kyphosis of thoracic and upper lumbar; IIIB, like a clasp knife, with a flat thoracic and lumbar angle; and IIIC, with bigger thoracic kyphosis and lumbar lordosis. The thoracolumbar kyphosis angle (°) of the three subtypes were −23.61 ± 5.37, −25.40 ± 7.71, and −40.01 ± 8.40, respectively. Lumbar lordosis was correlated with thoracic kyphosis (IIIA, r = −0.600, p = 0.005; IIIB, r = −0.312, p = 0.046; IIIC, r = −0.657, p = 0.015), and correlated with sacral slope (IIIA, r = 0.537, p = 0.015; IIIB, r = 0.654, p = 0.000; IIIC, r = 0.578, p = 0.039). All spinopelvic parameters were compared between the Sagittal Balance group and the Sagittal Imbalance group, and only the thoracolumbar kyphosis angle showed statistical difference (t = −2.247, p = 0.028). Conclusions: The common characteristics of thoracolumbar junctional kyphosis were found to be a bigger thoracolumbar junctional angle and vertex of kyphosis located in the thoracolumbar junction (T10-L2). Despite TLJK, a change in the thoracic angle was still important to maintain sagittal balance. The thoracolumbar junction plays an important role in sagittal alignment and balance.

show abstract

Junctional Failure After Thoracolumbar Kyphosis Correction in Patients with Ankylosing Spondylitis

Cited by 2 publications

References 26 publications

Multilevel Pedicle Subtraction Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Clinical Effect and Biomechanical Evaluation

Multilevel Pedicle Subtraction Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Clinical Effect and Biomechanical Evaluation

Thoracolumbar/Lumbar Degenerative Kyphosis—The Importance of Thoracolumbar Junction in Sagittal Alignment and Balance

Contact Info

Product

Resources

About