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ASKyphoplan: a program for deformity planning in ankylosing spondylitis.

van Royen BJ, Scheerder FJ, Jansen E, Smit TH - Eur Spine J (2007)

Bottom Line: Adequate deformity planning is essential for reliable prediction of the effect of surgical correction of the spine on the sagittal balance and horizontal gaze of the patient.However, this mathematical equation is not easily used in daily practice.The steps taken during an ASKyphoplan run are outlined, and the clinical application is discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, VU University Medical Center, P.O. Box 7057, 1007, MB Amsterdam, The Netherlands. bj.vanroyen@vumc.nl

ABSTRACT
A closing wedge osteotomy of the lumbar spine may be considered to correct posture and spinal balance in progressive thoracolumbar kyphotic deformity caused by ankylosing spondylitis (AS). Adequate deformity planning is essential for reliable prediction of the effect of surgical correction of the spine on the sagittal balance and horizontal gaze of the patient. The effect of a spinal osteotomy on the horizontal gaze is equal to the osteotomy angle. However, the effect of a spinal osteotomy on the sagittal balance depends on both the correction angle and the level of osteotomy simultaneously. The relation between the correction angle, the level of osteotomy and the sagittal balance of the spine can be expressed by a mathematical equation. However, this mathematical equation is not easily used in daily practice. We present the computer program ASKyphoplan that analyses and visualizes the planning procedure for sagittal plane corrective osteotomies of the spine in AS. The relationship between the planned correction angle, level of osteotomy and sagittal balance are coupled into the program. The steps taken during an ASKyphoplan run are outlined, and the clinical application is discussed. The application of the program is illustrated by the analysis of the data from a patient recently treated by a lumbar osteotomy in AS. The software can be used free of charge on the internet at http://www.stega.nl under the heading "research" in the menu.

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Related in: MedlinePlus

During the closure procedure lateral images of the lumbar spine from the image intensifier were sent wireless to the local PACS at regular times (a). The correction is measured in degrees by measuring the Cobb angle on the acquired images between the upper and lower endplate of L4 regularly, until the required correction angle was achieved (b)
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Fig4: During the closure procedure lateral images of the lumbar spine from the image intensifier were sent wireless to the local PACS at regular times (a). The correction is measured in degrees by measuring the Cobb angle on the acquired images between the upper and lower endplate of L4 regularly, until the required correction angle was achieved (b)

Mentions: A 29 year-old man with a 8 year history of AS and a progressive TLKD is indicated for lumbar osteotomy (Fig. 2a). The standard full-length lateral radiograph of the whole spine showed a pre-operative SEA of 14°. Rotation of the radiograph onto the co-ordinate system with the SEA at 40° resulted in a pre-operative SVA of 384 mm (Fig. 3). Planning a SVA 75 mm anterior to the posterior superior corner of the sacral endplate, a correction angle of 43° at level L4 is required. In addition, a 43° correction at L4 will correct the CBVA with 17° (Fig. 3). The surgical procedure, including positioning of the patient, anaesthesia and surgical technique was performed according to the technique described earlier [8]. During the closure procedure of the closing wedge osteotomy, lateral images of the lumbar spine from the image intensifier were sent wireless to the local PACS at regular times. The acquired correction was measured in degrees by measuring the Cobb angle on the acquired images between the upper and lower endplate of L4 regularly, using ‘measuring angle’ tool displayed on the digital system, until the required correction angle was achieved (Fig. 4a, b). The post-operative radiograph of the lumbar spine showed a correction of 40° in L4. There were no complications during surgery and follow-up treatment. The clinical postoperative CBVA showed to be 27 (Fig. 2b).Fig. 2


ASKyphoplan: a program for deformity planning in ankylosing spondylitis.

van Royen BJ, Scheerder FJ, Jansen E, Smit TH - Eur Spine J (2007)

During the closure procedure lateral images of the lumbar spine from the image intensifier were sent wireless to the local PACS at regular times (a). The correction is measured in degrees by measuring the Cobb angle on the acquired images between the upper and lower endplate of L4 regularly, until the required correction angle was achieved (b)
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2200734&req=5

Fig4: During the closure procedure lateral images of the lumbar spine from the image intensifier were sent wireless to the local PACS at regular times (a). The correction is measured in degrees by measuring the Cobb angle on the acquired images between the upper and lower endplate of L4 regularly, until the required correction angle was achieved (b)
Mentions: A 29 year-old man with a 8 year history of AS and a progressive TLKD is indicated for lumbar osteotomy (Fig. 2a). The standard full-length lateral radiograph of the whole spine showed a pre-operative SEA of 14°. Rotation of the radiograph onto the co-ordinate system with the SEA at 40° resulted in a pre-operative SVA of 384 mm (Fig. 3). Planning a SVA 75 mm anterior to the posterior superior corner of the sacral endplate, a correction angle of 43° at level L4 is required. In addition, a 43° correction at L4 will correct the CBVA with 17° (Fig. 3). The surgical procedure, including positioning of the patient, anaesthesia and surgical technique was performed according to the technique described earlier [8]. During the closure procedure of the closing wedge osteotomy, lateral images of the lumbar spine from the image intensifier were sent wireless to the local PACS at regular times. The acquired correction was measured in degrees by measuring the Cobb angle on the acquired images between the upper and lower endplate of L4 regularly, using ‘measuring angle’ tool displayed on the digital system, until the required correction angle was achieved (Fig. 4a, b). The post-operative radiograph of the lumbar spine showed a correction of 40° in L4. There were no complications during surgery and follow-up treatment. The clinical postoperative CBVA showed to be 27 (Fig. 2b).Fig. 2

Bottom Line: Adequate deformity planning is essential for reliable prediction of the effect of surgical correction of the spine on the sagittal balance and horizontal gaze of the patient.However, this mathematical equation is not easily used in daily practice.The steps taken during an ASKyphoplan run are outlined, and the clinical application is discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, VU University Medical Center, P.O. Box 7057, 1007, MB Amsterdam, The Netherlands. bj.vanroyen@vumc.nl

ABSTRACT
A closing wedge osteotomy of the lumbar spine may be considered to correct posture and spinal balance in progressive thoracolumbar kyphotic deformity caused by ankylosing spondylitis (AS). Adequate deformity planning is essential for reliable prediction of the effect of surgical correction of the spine on the sagittal balance and horizontal gaze of the patient. The effect of a spinal osteotomy on the horizontal gaze is equal to the osteotomy angle. However, the effect of a spinal osteotomy on the sagittal balance depends on both the correction angle and the level of osteotomy simultaneously. The relation between the correction angle, the level of osteotomy and the sagittal balance of the spine can be expressed by a mathematical equation. However, this mathematical equation is not easily used in daily practice. We present the computer program ASKyphoplan that analyses and visualizes the planning procedure for sagittal plane corrective osteotomies of the spine in AS. The relationship between the planned correction angle, level of osteotomy and sagittal balance are coupled into the program. The steps taken during an ASKyphoplan run are outlined, and the clinical application is discussed. The application of the program is illustrated by the analysis of the data from a patient recently treated by a lumbar osteotomy in AS. The software can be used free of charge on the internet at http://www.stega.nl under the heading "research" in the menu.

Show MeSH
Related in: MedlinePlus