Osteotomy of the Spine for Correction of Flexion Deformity in Rheumatoid Arthritis

Smith-Petersen, M. N.; Larson, Carroll B.; Aufranc, Otto E.

doi:10.1097/00003086-196909000-00003

Cited by 212 publications

(180 citation statements)

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“…Urist 19 first described the use of cervical extension osteotomy for correction of a chin-on-chest deformity in a patient with AS. This procedure was adapted from Smith-Petersen and colleagues' 16 description of lumbar osteotomies in patients with lumbar flexion deformities. Urist's technique involved removing a posterior wedge of bone from C-7 with subsequent gradual extension of the head and neck to "close" the osteotomy defect and achieve sagittal correction.…”

Section: Treatment Of Asmentioning

confidence: 99%

Management of cervical deformity in ankylosing spondylitis

Hoh

Khoueir

Wang

2008

FOC

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✓ Ankylosing spondylitis can lead to severe cervical kyphosis, causing problems with forward vision, swallowing, hygiene, patient functionality, and social outlook. Evaluation of patients with cervical flexion deformity includes assessment of global sagittal balance and chin–brow angle. The primary treatment in extreme disabling cases is surgical correction involving a posterior cervical extension osteotomy, which is a technically demanding procedure with considerable risk of neurological injury. To address the potential complications with extension osteotomy, the authors of several reports have described modifications to the surgical technique. These developments incorporate recent advances in anesthesia, neuromonitoring, and spinal instrumentation. Complications associated with the procedure include subluxation at the osteotomy level, spinal cord injury, radiculopathy, dysphagia, and pseudarthrosis. Although the risks of spinal correction are considerable, extension osteotomy remains an effective treatment modality for patients with disabling cervical flexion deformity.

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Section: Treatment Of Asmentioning

confidence: 99%

Management of cervical deformity in ankylosing spondylitis

Hoh

Khoueir

Wang

2008

FOC

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“…Smith-Peterson first described an extension osteotomy to correct flexion deformities of the lumbar spine in patients with rheumatoid arthritis in 1945. 6 This Smith-Peterson osteotomy (SPO) involves removing the laminae and facet joints to decompress the nerve roots prior to applying an extension force to distract the anterior column through the disc space while simultaneously compressing the posterior column along the osteotomy. In contrast to a PSO, SmithPeterson's osteotomy (SPO) does not involve resection of the pedicle or lateral wall of the vertebral body.…”

Section: Discussionmentioning

confidence: 99%

Pedicle Reduction Osteotomy in the Upper Cervical Spine: Technique, Case Report and Review of the Literature

et al. 2015

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ObjectiveTo present a case report of the correction of a degenerative cervical 45-degree kyphosis centered at C4 with a single stage PSO. Summary of Background DataCorrection of a fixed cervical kyphosis is a surgical challenge that is frequently managed with a combination of anterior and posterior surgical procedures. An alternative the three stage operation is a single stage pedicle subtraction osteotomy (PSO). A PSO releases the posterior, middle and anterior columns of the spine by resecting the facet joints, pedicles, and a portion of the vertebral body at the apex of a kyphosis through a posterior approach. MethodsThis was a case report of a patient who had degenerative cervical 45 degree kyphosis and was corrected with a single stage pedicle subtraction osteotomy. We did a literature review to provide information on current techniques to treat these patients. ResultsWith careful resection of the lateral mass and decompression of the vertebral artery by removal of the posterior margin of the foramen transversarium the upper cervical pedicles can be accessed and a PSO can be performed. The vertebral arteries were not obstructed or kinked with posterior reduction of the PSO in this case. ConclusionsA closing wedge PSO is a useful tool for correcting fixed kyphotic deformities in the upper cervical spine. Further studies are necessary to evaluate the long-term outcomes in these patients.keywords: pedicle reduction osteotomy, Cervical Spine, surgical technique Volume 9 Article 57

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“…The SPO was first described in 1945 for flexion deformity due to rheumatoid arthritis. 53 The procedure originally involved resection of the spinous processes and facets of the lumbar spine but has been modified by many subsequent authors. Resection includes the superior articular facet at the caudal level and the inferior articular facet of the cephalad vertebra.…”

Section: Neurosurg Focus / Volume 24 / January 2008mentioning

confidence: 99%