Significance of Chin-brow Vertical Angle in Correction of Kyphotic Deformity of Ankylosing Spondylitis Patients

Suk, Kyung Soo; Kim, Ki Tack; Kim, Jin Moon; Chung, Kwang Hoon

doi:10.4184/jkss.2002.9.2.115

Cited by 13 publications

(23 citation statements)

References 17 publications

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“…In a world where appearance and health become increasingly important for social acceptance and well-being, the inability to function at the level of one's peers due to pain or deformity can create a huge psychological burden. As the recognition, evaluation, and treatment of spinal deformity continues to progress, there are many emerging new methods for the treatment of kyphoscoliosis, including common VCR, SPO (SmithPetersen osteotomy), PSO (pedicle subtraction osteotomy), PVCR, and eggshell methods [5,8,28,33]. In general, for minor degree of imbalance and curve less than 70°and 50°i n coronal and sagittal planes, posterior soft tissue release with compression on the convex side should be sufficient to produce moderate correction and balance [11].…”

Section: Discussionmentioning

confidence: 99%

A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases

Wang

Zhang

et al. 2008

Eur Spine J

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We report a multilevel modified vertebral column resection (MVCR) through a single posterior approach and clinical outcomes for treatment of severe congenital rigid kyphoscoliosis in adults. Transpedicular eggshell osteotomies and vertebral column resection are two techniques for the surgical treatment of rigid severe spine deformities. The authors developed a new technique combining the two surgical methods as a MVCR, through a single posterior approach, for surgical treatment of severe congenital rigid kyphoscoliosis in adults. Thirteen adult patients with severe rigid congenital kyphoscoliosis deformity were treated by a single posterior approach using a MVCR technique. The surgery processes included a onestage posterior transpedicular eggshell technique first, and then expanded the eggshell technique to adjacent intervertebra space through abrasive reduction of the vertebral cortices from inside out. All posterior vertebral elements were removed including the cortical vertebral bone around the neural canal. Range of resection of the vertebral column at the apex of the deformity included apical vertebra and both cephalic and/or caudal adjacent wedged vertebrae. Totally, 32 vertebrae had been removed in 13 patients, with 2.42 vertebrae being removed on average in each case. The average fusion extent was 7.69 vertebrae. Mean operation time was 266 min with average blood loss of 2,411.54 ml during operation. Patients were followed up for an average duration of 2.54 years. Deformity correction was 59% in the coronal plane (from 79.7°to 32.4°) postoperatively and 33.7°(57% correction) at 2 years followup. In the sagittal plane, correction was from preoperative 85.9°to 27.5°immediately after operation, and 32.0°at 2 years follow-up. Postoperative pain was reduced from preoperative 1.77 to 0.54 at 2 years follow-up in visual analog scale. SRS-24 scale was from 38.2 preoperatively to 76.9 at 2 years follow-up postoperative. Complications were encountered in four patients (30.7%) with transient neurology that spontaneously improved without further treatment within 3 months. MVCR technique through a single posterior approach is an effective procedure for the surgical treatment of severe congenital rigid kyphoscoliosis in adults.

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Section: Discussionmentioning

confidence: 99%

A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases

Wang

Zhang

et al. 2008

Eur Spine J

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“…Therefore, the standing position of the patient represents the maximal posterior tilt of the pelvis, which is proved radiological by the orientation of sacral slope which may reach a complete horizontal orientation. This position is biomechanically inefficient, and painful, and the patient fatigues easily while walking or standing [3][4][5][6][7][8]. As hips are in maximal extension, there is a limited posterior gait step, increasing trunk forward imbalance when walking.…”

Section: Introductionmentioning

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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“…Earlier studies have addressed postoperative changes of sagittal balance in AS [2,7,8,14,18,21], and several authors have investigated relationships between HRQOL instruments and radiographic measurements to define objective criteria for the surgical treatment of adult spinal deformities. However, relatively few studies have addressed relations between AS and specific radiologic pelvic parameters.…”

Section: Discussionmentioning

confidence: 99%

Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis

et al. 2013

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Purpose Little data are available on the relationship between sagittal spinopelvic parameters and health related quality of life (HRQOL) in ankylosing spondylitis (AS) patients. The aim of this study was to identify the relationships between spinopelvic parameters and HRQOL in AS. Methods The study and control groups comprised 107 AS patients and 40 controls. All underwent anteroposterior and lateral radiographs of the whole spine including hip joints and completed clinical questionnaires. The radiographic parameters examined were sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis. A Visual Analogue Scale (VAS: 0-10) score for back pain, the Oswestry disability index (ODI) questionnaire, Scoliosis Research Society (SRS-22) questionnaire and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were administered to evaluate QOL. Statistical analysis was performed to identify significant differences between the study and control groups. In addition, correlations between radiological parameters and clinical questionnaires were sought. Results The AS patients and controls were found to be significantly different in terms of sagittal vertical axis, sacral slope, pelvic tilt, pelvic incidence, and lumbar lordosis. However, no significant intergroup difference was observed for thoracic kyphosis (P [ 0.05). Of the 107 AS patients, there were 18 women and 89 men. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. Multiple regression analysis was performed to identify predictors of clinical outcome, and the results obtained revealed that sagittal vertical axis and sacral slope significantly predicted VAS, ODI and BASDAI scores and that sagittal vertical axis and lumbar lordosis predicted SRS-22 scores. Conclusions AS patients and normal controls were found to be significantly different in terms of sagittal spinopelvic parameters. Correlation analysis revealed significant relationships between radiographic parameters and clinical outcomes. In particular, sagittal vertical axis, sacral slope and lumbar lordosis were found to be significant parameters in prediction of clinical outcomes in AS patient.

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Significance of Chin-brow Vertical Angle in Correction of Kyphotic Deformity of Ankylosing Spondylitis Patients

Cited by 13 publications

References 17 publications

A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases

A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases

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

Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis

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