Debridement and interbody fusion via posterior pedicle lateral approach for ankylosing spondylitis with thoracolumbar Andersson lesion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DING Keyuan ¹ , ZHU Jinwen ² , CHEN Hao ¹ , TIAN Ye ¹ ,  HAO Dingjun ²

1. Xi’an Medical University, Xi’an Shaanxi, 710021, P.R.China;
2. Department of Spine Surgery, Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

HAO Dingjun, Email: haodingjun@126.com

Keywords：

Andersson lesion; ankylosing spondylitis; thoracolumbar spine; lesion debridement; intervertebral bone grafting

DOI：

10.7507/1002-1892.201904068

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the safety and effectiveness of debridement and interbody fusion via posterior pedicle lateral approach in treatment of ankylosing spondylitis with thoracolumbar Andersson lesion (AL).Methods Between October 2011 and January 2017, 10 patients of ankylosing spondylitis with thoracolumbar AL were treated with debridement via posterior pedicle lateral approach and interbody fusion with bone grafting. There were 8 males and 2 females with an average age of 48.8 years (range, 31-79 years). The disease duration was 1.5-48.0 months (mean, 10.6 months). All patients were single-segment lesion, including 3 cases of T_{10, 11}, 4 cases of T_{11, 12}, and 3 cases of T₁₂, L₁. The preoperative visual analogue scale (VAS) score was 8.0±0.8, the Oswestry disability index (ODI) was 68.8%±5.5%, and the Cobb angle of local kyphosis was (26.3±7.1)°. According to American Spinal Injury Association (ASIA) scoring system, neurological impairment was assessed in 1 case of grade C, 4 cases of grade D, and 5 cases of grade E.Results All the operations of 10 patients completed successfully. The operation time was 120-185 minutes (mean, 151.5 minutes), and the intraoperative blood loss was 300-750 mL (mean, 450.0 mL). Dural sac tear occurred in 1 case during operation and was repaired, with no cerebrospinal fluid leakage after operation. All patients were followed up 24-50 months (mean, 31.2 months). At last follow-up, the VAS score was 1.9±0.9 and ODI was 13.0%±3.0%, showing significant differences when compared with preoperative ones (t=17.530, P=0.000; t=31.890, P=0.000). Neurological function was improved significantly at 24 months after operation, and rated as ASIA grade E. The Cobb angles were (12.6±4.6)° at 3 days and (13.6±4.6)° at 24 months after operation, which were significantly different from those before operation (P<0.05); there was no significant difference between 3 days and 24 months after operation (P>0.05). At 24 months after operation, the grafted bone obtained good fusion at AL segment. During the follow-up, there was no failure of internal fixation such as nail withdrawal, broken nail, and broken rod.Conclusion Debridement and interbody fusion via posterior pedicle lateral approach for the ankylosing spondylitis with thoracolumbar AL can achieve satisfactory effectiveness, good fusion, and a certain correction of local kyphosis.

Citation： DING Keyuan, ZHU Jinwen, CHEN Hao, TIAN Ye, HAO Dingjun. Debridement and interbody fusion via posterior pedicle lateral approach for ankylosing spondylitis with thoracolumbar Andersson lesion. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1474-1479. doi: 10.7507/1002-1892.201904068 Copy

1.	Lukasiewicz AM, Bohl DD, Varthi AG, et al. Spinal fracture in patients with ankylosing spondylitis: Cohort definition, distribution of injuries, and Hospital Outcomes. Spine (Phila Pa 1976), 2016, 41(3): 191-196.
2.	Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J, 2009, 18(2): 145-156.
3.	Feldtkeller E, Vosse D, Geusens P, et al. Prevalence and annual incidence of vertebral fractures in patients with ankylosing spondylitis. Rheumatol Int, 2006, 26(3): 234-239.
4.	Britto NMF, Renor BS, Ghizoni E, et al. Spine surgery in patients with ankylosing spondylitis. Rev Assoc Med Bras (1992), 2018, 64(4): 379-383.
5.	Mitra D, Elvins DM, Speden DJ, et al. The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology (Oxford), 2000, 39(1): 85-89.
6.	Peh WC, Luk KD. Pseudoarthrosis in ankylosing spondylitis. Ann Rheum Dis, 1994, 53(3): 206-210.
7.	Kim KT, Lee SH, Suk KS, et al. Spinal pseudarthrosis in advanced ankylosing spondylitis with sagittal plane deformity: clinical characteristics and outcome analysis. Spine (Phila Pa 1976), 2007, 32(15): 1641-1647.
8.	Qian BP, Qiu Y, Wang B, et al. Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis. Eur Spine J, 2012, 21(4): 711-718.
9.	薛镜, 刘立岷, 宋跃明, 等. 经后路骨折间隙截骨治疗强直性脊柱炎胸腰椎应力骨折. 中国修复重建外科杂志, 2018, 32(5): 531-535.
10.	Bron JL, de Vries MK, Snieders MN, et al. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol, 2009, 28(8): 883-892.
11.	Park YS, Kim JH, Ryu JA, et al. The Andersson lesion in ankylosing spondylitis: distinguishing between the inflammatory and traumatic subtypes. J Bone Joint Surg (Br), 2011, 93(7): 961-966.
12.	Langlois S, Cedoz JP, Lohse A, et al. Aseptic discitis in patients with ankylosing spondylitis: a retrospective study of 14 cases. Joint Bone Spine, 2005, 72(3): 248-253.
13.	Fang D, Leong JC, Ho EK, et al. Spinal pseudarthrosis in ankylosing spondylitis. Clinicopathological correlation and the results of anterior spinal fusion. J Bone Joint Surg (Br), 1988, 70(3): 443-447.
14.	Dave BR, Ram H, Krishnan A. Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation. Eur Spine J, 2011, 20(9): 1503-1509.
15.	Chang KW, Tu MY, Huang HH, et al. Posterior correction and fixation without anterior fusion for pseudoarthrosis with kyphotic deformity in ankylosing spondylitis. Spine (Phila Pa 1976), 2006, 31(13): E408-E413.
16.	Wang T, Wang D, Cong Y, et al. Evaluating a posterior approach for surgical treatment of thoracolumbar pseudarthrosis in ankylosing spondylitis. Clin Spine Surg, 2017, 30(1): E13-E18.
17.	Zhang X, Wang Y, Wu B, et al. Treatment of Andersson lesion-complicating ankylosing spondylitis via transpedicular subtraction and disc resection osteotomy, a retrospective study. Eur Spine J, 2016, 25(8): 2587-2595.
18.	Zhang W, Zheng M. Operative strategy for different types of thoracolumbar stress fractures in ankylosing spondylitis. J Spinal Disord Tech, 2014, 27(8): 423-430.
19.	周思宇, 孙卓然, 李危石. 矢状位平衡影像学评价之争议与现状. 中国修复重建外科杂志, 2018, 32(11): 1365-1370.
20.	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.
21.	Van Royen BJ, Kastelijns RC, Noske DP, et al. Transpedicular wedge resection osteotomy for the treatment of a kyphotic Andersson lesion-complicating ankylosing spondylitis. Eur Spine J, 2006, 15(2): 246-252.
22.	Zheng GQ, Song K, Zhang YG, et al. Two-level spinal osteotomy for severe thoracolumbar kyphosis in ankylosing spondylitis. Experience with 48 patients. Spine (Phila Pa 1976), 2014, 39(13): 1055-1058.
23.	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.
24.	Liang Y, Tang X, Zhao Y, et al. Posterior wedge osteotomy and debridement for Andersson lesion with severe kyphosis in ankylosing spondylitis. J Orthop Surg Res, 2017, 12(1): 54.
25.	El-Sharkawi MM, Koptan WM, El-Miligui YH, et al. Comparison between pedicle subtraction osteotomy and anterior corpectomy and plating for correcting post-traumatic kyphosis: a multicenter study. Eur Spine J, 2011, 20(9): 1434-1440.

1. Lukasiewicz AM, Bohl DD, Varthi AG, et al. Spinal fracture in patients with ankylosing spondylitis: Cohort definition, distribution of injuries, and Hospital Outcomes. Spine (Phila Pa 1976), 2016, 41(3): 191-196.
2. Westerveld LA, Verlaan JJ, Oner FC. Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J, 2009, 18(2): 145-156.
3. Feldtkeller E, Vosse D, Geusens P, et al. Prevalence and annual incidence of vertebral fractures in patients with ankylosing spondylitis. Rheumatol Int, 2006, 26(3): 234-239.
4. Britto NMF, Renor BS, Ghizoni E, et al. Spine surgery in patients with ankylosing spondylitis. Rev Assoc Med Bras (1992), 2018, 64(4): 379-383.
5. Mitra D, Elvins DM, Speden DJ, et al. The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology (Oxford), 2000, 39(1): 85-89.
6. Peh WC, Luk KD. Pseudoarthrosis in ankylosing spondylitis. Ann Rheum Dis, 1994, 53(3): 206-210.
7. Kim KT, Lee SH, Suk KS, et al. Spinal pseudarthrosis in advanced ankylosing spondylitis with sagittal plane deformity: clinical characteristics and outcome analysis. Spine (Phila Pa 1976), 2007, 32(15): 1641-1647.
8. Qian BP, Qiu Y, Wang B, et al. Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis. Eur Spine J, 2012, 21(4): 711-718.
9. 薛镜, 刘立岷, 宋跃明, 等. 经后路骨折间隙截骨治疗强直性脊柱炎胸腰椎应力骨折. 中国修复重建外科杂志, 2018, 32(5): 531-535.
10. Bron JL, de Vries MK, Snieders MN, et al. Discovertebral (Andersson) lesions of the spine in ankylosing spondylitis revisited. Clin Rheumatol, 2009, 28(8): 883-892.
11. Park YS, Kim JH, Ryu JA, et al. The Andersson lesion in ankylosing spondylitis: distinguishing between the inflammatory and traumatic subtypes. J Bone Joint Surg (Br), 2011, 93(7): 961-966.
12. Langlois S, Cedoz JP, Lohse A, et al. Aseptic discitis in patients with ankylosing spondylitis: a retrospective study of 14 cases. Joint Bone Spine, 2005, 72(3): 248-253.
13. Fang D, Leong JC, Ho EK, et al. Spinal pseudarthrosis in ankylosing spondylitis. Clinicopathological correlation and the results of anterior spinal fusion. J Bone Joint Surg (Br), 1988, 70(3): 443-447.
14. Dave BR, Ram H, Krishnan A. Andersson lesion: are we misdiagnosing it? A retrospective study of clinico-radiological features and outcome of short segment fixation. Eur Spine J, 2011, 20(9): 1503-1509.
15. Chang KW, Tu MY, Huang HH, et al. Posterior correction and fixation without anterior fusion for pseudoarthrosis with kyphotic deformity in ankylosing spondylitis. Spine (Phila Pa 1976), 2006, 31(13): E408-E413.
16. Wang T, Wang D, Cong Y, et al. Evaluating a posterior approach for surgical treatment of thoracolumbar pseudarthrosis in ankylosing spondylitis. Clin Spine Surg, 2017, 30(1): E13-E18.
17. Zhang X, Wang Y, Wu B, et al. Treatment of Andersson lesion-complicating ankylosing spondylitis via transpedicular subtraction and disc resection osteotomy, a retrospective study. Eur Spine J, 2016, 25(8): 2587-2595.
18. Zhang W, Zheng M. Operative strategy for different types of thoracolumbar stress fractures in ankylosing spondylitis. J Spinal Disord Tech, 2014, 27(8): 423-430.
19. 周思宇, 孙卓然, 李危石. 矢状位平衡影像学评价之争议与现状. 中国修复重建外科杂志, 2018, 32(11): 1365-1370.
20. 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.
21. Van Royen BJ, Kastelijns RC, Noske DP, et al. Transpedicular wedge resection osteotomy for the treatment of a kyphotic Andersson lesion-complicating ankylosing spondylitis. Eur Spine J, 2006, 15(2): 246-252.
22. Zheng GQ, Song K, Zhang YG, et al. Two-level spinal osteotomy for severe thoracolumbar kyphosis in ankylosing spondylitis. Experience with 48 patients. Spine (Phila Pa 1976), 2014, 39(13): 1055-1058.
23. 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.
24. Liang Y, Tang X, Zhao Y, et al. Posterior wedge osteotomy and debridement for Andersson lesion with severe kyphosis in ankylosing spondylitis. J Orthop Surg Res, 2017, 12(1): 54.
25. El-Sharkawi MM, Koptan WM, El-Miligui YH, et al. Comparison between pedicle subtraction osteotomy and anterior corpectomy and plating for correcting post-traumatic kyphosis: a multicenter study. Eur Spine J, 2011, 20(9): 1434-1440.

Chinese Journal of Reparative and Reconstructive Surgery

Debridement and interbody fusion via posterior pedicle lateral approach for ankylosing spondylitis with thoracolumbar Andersson lesion

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content