Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients

Zhijun Xin,Peng Huang,Guoquan Zheng,Yan Wang,Xuesong Zhang

doi:10.1186/s13018-019-1371-y

Zhijun Xin, Peng Huang + Show 3 more

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https://doi.org/10.1186/s13018-019-1371-y

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Abstract

ObjectiveTo report the clinical results and surgical tactics of spinal osteotomy for ankylosing spondylitis (AS) kyphosis based on the experiences of 428 patients.MethodsFrom January 2003 to January 2015, a total of 428 patients suffering from AS kyphosis who underwent a one- or two-level pedicle subtraction osteotomy (PSO) or vertebral column decancellation (VCD) osteotomy in our hospital were reviewed. Pre- and postoperative radiological parameters and the chin-brow vertical angle (CBVA) were measured. Intraoperative, postoperative, and general complications were recorded.ResultsAll patients could walk with horizontal vision and lie on their backs postoperatively. The pre- and postoperative average global kyphosis (GK) angles were corrected from 82.6 to 12.7° (p = 0.000) in the two-level group and from 55.8 to 9.6° (p = 0.000) in the one-level group, respectively. The mean sagittal vertical axis (SVA) improved from 29.4 to 8 cm (p = 0.000) in the two-level group and from 18.0 to 4.3 cm (p = 0.000) in the one-level group. The CBVA improved from 68.3 to 8.2° (p = 0.000) in the two-level group and from 46.2 to 4.2° (p = 0.000) in the one-level group. Although no major acute complications such as death or complete paralysis occurred, the complication rate was 6.5% in the one-level group and 23.6% in the two-level group.ConclusionSpinal osteotomy, such as PSO and VCD, can improve the quality of life of AS patients as well as correct kyphotic deformities. The one-level spinal osteotomy showed a lower complication rate, while two-level spinal osteotomy was a relatively aggressive procedure that was more suitable in correcting severe AS kyphotic deformities.

Highlights

Ankylosing spondylitis (AS) is a chronic spondyloarthropathy that primarily involves the spine and sacroiliac joints [1,2,3]
All patients demonstrated changes in the pre- and postoperative radiological parameters and the chin-brow vertical angle (CBVA), while no significant differences were demonstrated in these parameters between the postoperative and final follow-up
We do not perform an osteotomy at L4 or L5 because L4 and L5 are not the apex vertebrae of lumbar lordosis [10], and fusion to the sacrum with a short lever arm on the distal part of fusion will result in discomfort or an inability to sit on the floor [32]. In view of these abovementioned considerations, we suggest that most osteotomy sites are located at the second and third lumbar vertebrae because the third vertebra is the apex of the lumbar spine and the second vertebra is usually near the thoracolumbar kyphosis

Summary

Introduction

Ankylosing spondylitis (AS) is a chronic spondyloarthropathy that primarily involves the spine and sacroiliac joints [1,2,3]. AS may be associated with severe sagittal imbalance, trunk collapse, and flexion-contracture deformities of the spine in the later stages, which may cause back pain, horizontal vision loss, or neurological deficits [4, 5]. Complications, such as walking difficulties, abdominal viscera compression, or lung dysfunction, may occur in patients with AS severe kyphotic deformities [6,7,8]. Surgical correction of kyphosis is necessary for many patients with AS deformities to restore sagittal balance and the ability to see straight ahead [1, 9]. The most effective and safe surgical procedure for AS-related symptomatic kyphotic deformities is still controversial [2, 8], and the planning processes, which have been explored to determine the ideal site and to calculate the exact angle required for an osteotomy, carry some limitations as well [10]

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