PEDICLE SUBTRACTION OSTEOTOMY FOR CORRECTION OF KYPHOSIS IN ANKYLOSING SPONDYLITIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Hui , ZHANG Yonggang , MAO Keya , ZHANG Xuesong , WANG Zheng , ZHENG Guoquan , WANG Yan.

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China. Corresponding author: WANG Yan, E-mail: 301wangyan@sina.com;

Corresponding author：

Keywords：

Ankylosing spondylitis; Kyphosis; Pedicle subtraction osteotomy; Lumbar vertebrae

DOI：

10.7507/1002-1892.20130092

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Objective To assess the effectiveness of single-level lumbar pedicle subtraction osteotomy for correction of kyphosis caused by ankylosing spondylitis. Methods Between July 2006 and July 2010, 45 consecutive patients with kyphosis caused by ankylosing spondylitis underwent single-level pedical subtraction osteotomy. There were 39 males and 6 females with an average age of 36.9 years (range, 21-59 years). The average disease duration was 18.6 years (range, 6-40 years). All patients had low back pain, fatigue, abnormal gaits, and disability of looking and lying horizontally. Radiological manifestations included sacroiliac joints fusion, bamboo spine, pelvic spin, and kyphosis. Cervical spine was involved in 30 patients; thoracolumbar spine was affected in 15 patients. Results Wound hydrops and dehiscence occurred in 1 case, and was cured after debridement; primary healing of incision was obtained in the other patients. Two patients had abdominal skin blisters, which were cured after magnesium sulfate wet packing. Forty-two patients were followed up 24-74 months (mean, 30 months). All osteotomy got solid fusion. The average bony fusion time was 6.8 months (range, 3-12 months). All patients could walk with brace and looked or lied horizontally postoperatively. The Scoliosis Research Society-22 Patient Questionnaire (SRS-22) score, T1-S1 kyphosis Cobb angle, L1-S1 lordosic Cobb angle, sagittal imbalance distance, and chin-brow vertical angle at 1 week and last follow-up were significantly improved when compared with those at preoperation (P lt; 0.05), but no significant difference was found between at 1 week and last follow-up (P gt; 0.05). Conclusion Single-level pedicle subtraction osteotomy has satisfactory effectiveness for the correction of kyphosis caused by ankylosing spondylitis.

Citation： XU Hui,ZHANG Yonggang,MAO Keya,ZHANG Xuesong,WANG Zheng,ZHENG Guoquan,WANG Yan.. PEDICLE SUBTRACTION OSTEOTOMY FOR CORRECTION OF KYPHOSIS IN ANKYLOSING SPONDYLITIS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(4): 389-392. doi: 10.7507/1002-1892.20130092 Copy

1.	Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg (Am), 2004, 86(1): 44-50.
2.	Gill JB, Levin A, Burd T, et al. Corrective osteotomies in spine surgery. J Bone Joint Surg (Am), 2008, 90(11): 2509-2520.
3.	Kiaer T, Gehrchen M. Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis. Eur Spine J, 2010, 19(1): 57-64.
4.	Berven SH, Deviren V, Smith JA, et al. Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine (Phila Pa 1976), 2001, 26(18): 2036-2043.
5.	Kim KT, Suk KS, Cho YJ, et al. Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine (Phila Pa 1976), 2002, 27(6): 612-618.
6.	Kim KT, Lee SH, Suk KS, et al. Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine (Phila Pa 1976), 2012, 37(19): 1667-1675.
7.	Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg (Am), 1945, 27(1): 1-11.
8.	Hehne HJ, Zielke K, Böhm H. Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis. Report on 177 cases. Clin Orthop Relat Res, 1990, (258): 49-55.
9.	Arun R, Dabke HV, Mehdian H. Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction. Eur Spine J, 2011, 20(12): 2252-2260.
10.	Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2037.
11.	Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res, 1985, (194): 142-152.
12.	Qian BP, Wang XH, Qiu Y, et al. The influence of closing-opening wedge osteotomy on sagittal balance in thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison with closing wedge osteotomy. Spine (Phila Pa 1976), 2012, 37(16): 1415-1423.
13.	Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between Smith-Petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2012 , 25(7): 383-390.
14.	毛克亚, 王岩, 张永刚, 等. 经椎弓根楔形截骨矫正强直性脊柱炎后凸畸形. 脊柱外科杂志, 2007, 5(2): 85-87.
15.	王岩, 毛克亚, 张永刚, 等. 双椎体截骨术矫正重度强直性脊柱炎后凸畸形. 中国脊柱脊髓杂志, 2009, 19(2): 108-112.
16.	Suk KS, Kim KT, Lee SH, et al. Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976), 2003, 28(17): 2001-2005.
17.	Debarge R, Demey G, Roussouly P. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J, 2011, 20 Suppl 5: 619-625.
18.	van Loon PJ, van Stralen G, van Loon CJ, et al. Pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of a rigid thoracolumbar hyperkyphosis; a preliminary report. Spine J, 2006, 6(2): 195-200.
19.	Kim YJ, Bridwell KH, Lenke LG, et al. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976), 2007, 32(20): 2189-2197.
20.	Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J, 2010, 19(1): 65-70.
21.	Bridwell KH, Lewis SJ, Edwards C, et al. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976), 28(18): 2093-2101.

1. Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg (Am), 2004, 86(1): 44-50.
2. Gill JB, Levin A, Burd T, et al. Corrective osteotomies in spine surgery. J Bone Joint Surg (Am), 2008, 90(11): 2509-2520.
3. Kiaer T, Gehrchen M. Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis. Eur Spine J, 2010, 19(1): 57-64.
4. Berven SH, Deviren V, Smith JA, et al. Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine (Phila Pa 1976), 2001, 26(18): 2036-2043.
5. Kim KT, Suk KS, Cho YJ, et al. Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine (Phila Pa 1976), 2002, 27(6): 612-618.
6. Kim KT, Lee SH, Suk KS, et al. Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine (Phila Pa 1976), 2012, 37(19): 1667-1675.
7. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg (Am), 1945, 27(1): 1-11.
8. Hehne HJ, Zielke K, Böhm H. Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis. Report on 177 cases. Clin Orthop Relat Res, 1990, (258): 49-55.
9. Arun R, Dabke HV, Mehdian H. Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction. Eur Spine J, 2011, 20(12): 2252-2260.
10. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2037.
11. Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res, 1985, (194): 142-152.
12. Qian BP, Wang XH, Qiu Y, et al. The influence of closing-opening wedge osteotomy on sagittal balance in thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison with closing wedge osteotomy. Spine (Phila Pa 1976), 2012, 37(16): 1415-1423.
13. Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between Smith-Petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2012 , 25(7): 383-390.
14. 毛克亚, 王岩, 张永刚, 等. 经椎弓根楔形截骨矫正强直性脊柱炎后凸畸形. 脊柱外科杂志, 2007, 5(2): 85-87.
15. 王岩, 毛克亚, 张永刚, 等. 双椎体截骨术矫正重度强直性脊柱炎后凸畸形. 中国脊柱脊髓杂志, 2009, 19(2): 108-112.
16. Suk KS, Kim KT, Lee SH, et al. Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976), 2003, 28(17): 2001-2005.
17. Debarge R, Demey G, Roussouly P. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J, 2011, 20 Suppl 5: 619-625.
18. van Loon PJ, van Stralen G, van Loon CJ, et al. Pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of a rigid thoracolumbar hyperkyphosis; a preliminary report. Spine J, 2006, 6(2): 195-200.
19. Kim YJ, Bridwell KH, Lenke LG, et al. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976), 2007, 32(20): 2189-2197.
20. Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J, 2010, 19(1): 65-70.
21. Bridwell KH, Lewis SJ, Edwards C, et al. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976), 28(18): 2093-2101.

Chinese Journal of Reparative and Reconstructive Surgery

PEDICLE SUBTRACTION OSTEOTOMY FOR CORRECTION OF KYPHOSIS IN ANKYLOSING SPONDYLITIS

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