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Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity.

Kim KT, Park DH, Lee SH, Lee JH - Clin Orthop Surg (2015)

Bottom Line: The outcome analysis showed a significant improvement in the ODI score (p < 0.05).There was no correlation between the clinical outcomes and spinopelvic parameters.The CCROM and postoperative SVA were important factors in determining the outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Spine Center, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.

ABSTRACT

Background: To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options.

Methods: We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores.

Results: A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9° ± 11.7° with PSO, 14.3° ± 8.4° with SPO, 38.3° ± 12.7° with PVCR, and 19.3° ± 7.1° with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p < 0.05). Statistical analysis revealed that the ODI score improvements correlated significantly with the postoperative SVA and CCROM (p < 0.05). There was no correlation between the clinical outcomes and spinopelvic parameters. There were 38 surgery-related complications in 25 patients (10.1%).

Conclusions: Corrective osteotomy is an effective method for treating a fixed kyphotic deformity occurring in ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.

No MeSH data available.


Related in: MedlinePlus

Diagram of the craniocervical range of motion.
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Figure 2: Diagram of the craniocervical range of motion.

Mentions: The radiological apex was defined as the farthest vertebrae from the line between the C2 vertebral body center and the midpoint of the upper sacral endplate. Based on this definition, kyphosis was classified into cervicothoracic (C1-T3), midthoracic (T4-T9), thoracolumbar (T10-L2), and lumbar (below L3) types according to the location of the apex (Fig. 1). The correction angle was defined as the angle between the superior end plate of the level above the osteotomy and the inferior end plate of the level below the osteotomy before and after the osteotomy. Several spinopelvic parameters were checked: SVA-the distance between the posterosuperior corners of the sacrum (PSCS) after drawing a perpendicular line from the C7 vertebral body center to the ground, thoracic kyphosis (TK)-the Cobb angle from T4 to T12, lumbar lordosis (LL)-the Cobb angle from L1 to S1, pelvic incidence (PI), pelvic tilt (PT). The craniocervical range of motion (CCROM) was devised to measure visual ranges determined by the angle between the posterosuperior tip of the hard palate to the caudal base of the occiput (McGregor line) and the T1 upper end plate on the cervical lateral flexion-extension image (Fig. 2).


Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity.

Kim KT, Park DH, Lee SH, Lee JH - Clin Orthop Surg (2015)

Diagram of the craniocervical range of motion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553281&req=5

Figure 2: Diagram of the craniocervical range of motion.
Mentions: The radiological apex was defined as the farthest vertebrae from the line between the C2 vertebral body center and the midpoint of the upper sacral endplate. Based on this definition, kyphosis was classified into cervicothoracic (C1-T3), midthoracic (T4-T9), thoracolumbar (T10-L2), and lumbar (below L3) types according to the location of the apex (Fig. 1). The correction angle was defined as the angle between the superior end plate of the level above the osteotomy and the inferior end plate of the level below the osteotomy before and after the osteotomy. Several spinopelvic parameters were checked: SVA-the distance between the posterosuperior corners of the sacrum (PSCS) after drawing a perpendicular line from the C7 vertebral body center to the ground, thoracic kyphosis (TK)-the Cobb angle from T4 to T12, lumbar lordosis (LL)-the Cobb angle from L1 to S1, pelvic incidence (PI), pelvic tilt (PT). The craniocervical range of motion (CCROM) was devised to measure visual ranges determined by the angle between the posterosuperior tip of the hard palate to the caudal base of the occiput (McGregor line) and the T1 upper end plate on the cervical lateral flexion-extension image (Fig. 2).

Bottom Line: The outcome analysis showed a significant improvement in the ODI score (p < 0.05).There was no correlation between the clinical outcomes and spinopelvic parameters.The CCROM and postoperative SVA were important factors in determining the outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Spine Center, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.

ABSTRACT

Background: To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options.

Methods: We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores.

Results: A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9° ± 11.7° with PSO, 14.3° ± 8.4° with SPO, 38.3° ± 12.7° with PVCR, and 19.3° ± 7.1° with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p < 0.05). Statistical analysis revealed that the ODI score improvements correlated significantly with the postoperative SVA and CCROM (p < 0.05). There was no correlation between the clinical outcomes and spinopelvic parameters. There were 38 surgery-related complications in 25 patients (10.1%).

Conclusions: Corrective osteotomy is an effective method for treating a fixed kyphotic deformity occurring in ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.

No MeSH data available.


Related in: MedlinePlus