Skip to main content

Advertisement

SpringerLink
Log in

Two-level pedicle subtraction osteotomy for severe thoracolumbar kyphotic deformity in ankylosing spondylitis

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Study design

A retrospective clinical study.

Objective

To evaluate the outcomes of two-level (T12 and L3) pedicle subtraction osteotomy (PSO) for severe thoracolumbar kyphosis in ankylosing spondylitis (AS), and to discuss the surgical strategies of this surgery.

Background

Cases were limited on the results of two-level PSO for correction of severe kyphosis caused by AS, nor on surgical strategies of this type of surgery.

Methods

From March 2006 to December 2010, nine consecutive AS patients with severe kyphotic deformity, underwent T12 and L3 PSOs. Chin-brow vertical angle (CBVA) and radiographic assessments which contain thoracic kyphosis (TK), lumbar lordosis (LL), global kyphosis (GK), and sagittal vertical axis were carefully recorded pre and postoperatively to evaluate the sagittal balance. Intra and postoperative complications were also registered. All patients were asked to fill out Oswestry Disability Index before surgery and at the last follow-up visit.

Results

All nine patients (8M/1F), averaged 41.4 years old (range 35–51 years), were received two-level (T12 and L3) PSO, and were followed up after surgery for a mean of 39.9 months (range 24–68 months). Good cosmetic results were achieved in all patients. Mean correction at two-level PSO was 67.9 ± 5.5°. All CBVA, TK, LL, and GK were changed significantly after surgery (P < 0.05), the mean amount of correction of which were 59.5 ± 13.8, 34.7 ± 3.8, 33.2 ± 2.4, and 54.0 ± 14.8 degrees, respectively, and with a small loss of correction at the last follow-up visit. Sagittal imbalance was significantly improved from 27.3 ± 4.4 to 3.4 ± 0.7 cm postoperatively. Neither mortalities nor any major neurological complications were found. The mean ODI score was significantly improved from 53.4 ± 15.5 before surgery to 8.2 ± 4.7 at the last visit.

Conclusion

The outcomes of follow-up showed that two-level (T12 and L3) PSO can effectively and safely correct severe thoracolumbar kyphosis in AS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

AS:

Ankylosing spondylitis

PSO:

Pedicle subtraction osteotomy

CBVA:

Chin-brow vertical angle

GK:

Global kyphosis

LL:

Lumbar lordosis

TK:

Thoracic kyphosis

SVA:

Sagittal vertical axis

ODI:

Oswestry disability index

SPO:

Smith-Petersen osteotomy

VCR:

Vertebral column resection

References

  1. El-Sharkawi MM, Koptan WM, El-Miligui YH, Said GZ (2011) Comparison between pedicle subtraction osteotomy and anterior corpectomy and plating for correcting post-traumatic kyphosis: a multicenter study. Europ spine j off publn Europ Spine Soc, Europ Spinal Deform Soc, Europ Sec Cervi Spine Res Soc 20:1434–1440. doi:10.1007/s00586-011-1720-y

    Article  Google Scholar 

  2. Feldtkeller E, Vosse D, Geusens P, van der Linden S (2006) Prevalence and annual incidence of vertebral fractures in patients with ankylosing spondylitis. Rheumatol Int 26:234–239. doi:10.1007/s00296-004-0556-8

    Article  PubMed  Google Scholar 

  3. Debarge R, Demey G, Roussouly P (2010) Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Europ spine j off publtn Europ Spine Soc, Europ Spinal Deform Soc, Europ Sec Cervic Spine Res Soc 19:65–70. doi:10.1007/s00586-009-1158-7

    Article  Google Scholar 

  4. Debarge R, Demey G, Roussouly P (2011) Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Europ spine j off publtn Europ Spine Soc, Europ Spinal Deform Soc, Europ Sec Cervic Spine Res Soc 20(Suppl 5):619–625. doi:10.1007/s00586-011-1929-9

    Article  Google Scholar 

  5. Kiaer T, Gehrchen M (2010) Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis. Europ spine j off publtn Europ Spine Soc, Europ Spinal Deform Soc, Europ Sec Cervic Spine Res Soc 19:57–64. doi:10.1007/s00586-009-1104-8

    Article  Google Scholar 

  6. Mitra D, Elvins DM, Speden DJ, Collins AJ (2000) The prevalence of vertebral fractures in mild ankylosing spondylitis and their relationship to bone mineral density. Rheumatology 39:85–89

    Article  CAS  PubMed  Google Scholar 

  7. Ragnarsdottir M, Geirsson AJ, Gudbjornsson B (2008) Rib cage motion in ankylosing spondylitis patients: a pilot study. Spine j off j North American Spine Soc 8:505–509. doi:10.1016/j.spinee.2006.12.009

    Article  Google Scholar 

  8. Pigge RR, Scheerder FJ, Smit TH, Mullender MG, van Royen BJ (2008) Effectiveness of preoperative planning in the restoration of balance and view in ankylosing spondylitis. Neurosurg Focus 24:E7. doi:10.3171/FOC/2008/24/1/E7

    Article  PubMed  Google Scholar 

  9. Smith-Petersen MN, Larson CB, Aufranc OE (1969) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 66:6–9

    CAS  PubMed  Google Scholar 

  10. Thomasen E (1985) Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop 194:142–152

    Google Scholar 

  11. Chen IH, Chien JT, Yu TC (2001) Transpedicular wedge osteotomy for correction of thoracolumbar kyphosis in ankylosing spondylitis: experience with 78 patients. Spine 26:E354–E360

    Article  CAS  PubMed  Google Scholar 

  12. Kim KT, Lee SH, Suk KS, Lee JH, Jeong BO (2012) Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine 37:1667–1675. doi:10.1097/BRS.0b013e3182552fd0

    Article  PubMed  Google Scholar 

  13. Kim KT, Suk KS, Cho YJ, Hong GP, Park BJ (2002) Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine 27:612–618

    Article  PubMed  Google Scholar 

  14. Qian BP, Wang XH, Qiu Y, Wang B, Zhu ZZ, Jiang J, Sun X (2012) The influence of closing–opening wedge osteotomy on sagittal balance in thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison with closing wedge osteotomy. Spine 37:1415–1423. doi:10.1097/BRS.0b013e318250dc95

    Article  PubMed  Google Scholar 

  15. Bridwell KH (2006) Decision making regarding Smith-Petersen versus pedicle subtraction osteotomy versus vertebral column resection for spinal deformity. Spine 31:S171–S178. doi:10.1097/01.brs.0000231963.72810.38

    Article  PubMed  Google Scholar 

  16. Suk KS, Kim KT, Lee SH, Kim JM (2003) Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine 28:2001–2005. doi:10.1097/01.BRS.0000083239.06023.78

    Article  PubMed  Google Scholar 

  17. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    CAS  PubMed  Google Scholar 

  18. Chang KW, Chen HC, Chen YY, Lin CC, Hsu HL, Cai YH (2006) Sagittal translation in opening wedge osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. Spine 31:1137–1142. doi:10.1097/01.brs.0000216479.09250.96

    Article  PubMed  Google Scholar 

  19. Qian BP, Qiu Y, Wang B, Sun X, Zhu ZZ, Jiang J, Ji ML (2012) Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis. Europ spine j off publtn Europ Spine Soc, Europ Spinal Deform Soc, Europ Sec Cervic Spine Res Soc 21:711–718. doi:10.1007/s00586-011-2054-5

    Article  Google Scholar 

  20. Boachie-Adjei O, Ferguson JA, Pigeon RG, Peskin MR (2006) Transpedicular lumbar wedge resection osteotomy for fixed sagittal imbalance: surgical technique and early results. Spine 31:485–492. doi:10.1097/01.brs.0000199893.71141.59

    Article  PubMed  Google Scholar 

  21. Gavaskar AS, Naveen Chowdary T (2011) Pedicle subtraction osteotomy for rigid kyphosis of the dorsolumbar spine. Arch Orthop Trauma Surg 131:803–808. doi:10.1007/s00402-010-1224-y

    Article  PubMed  Google Scholar 

  22. Wang Y, Zhang Y, Mao K, Zhang X, Wang Z, Zheng G, Li G, Wood KB (2010) Transpedicular bivertebrae wedge osteotomy and discectomy in lumbar spine for severe ankylosing spondylitis. J spinal disord tech 23:186–191. doi:10.1097/BSD.0b013e3181a5abde

    Article  PubMed  Google Scholar 

  23. Van Royen BJ, Toussaint HM, Kingma I, Bot SD, Caspers M, Harlaar J, Wuisman PI (1998) Accuracy of the sagittal vertical axis in a standing lateral radiograph as a measurement of balance in spinal deformities. Europ spine j off publtn Europ Spine Soc, Europ Spinal Deform Soc, Europ Sec Cervic Spine Res Soc 7:408–412

    Article  Google Scholar 

  24. Van Royen BJ, De Gast A, Smit TH (2000) Deformity planning for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Europ spine j off publtn Europ Spine Soc, Europ Spinal Deform Soc, Europ Sec Cervic Spine Res Soc 9:492–498

    Article  Google Scholar 

  25. Yang BP, Ondra SL, Chen LA, Jung HS, Koski TR, Salehi SA (2006) Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. J neurosurg Spine 5:9–17. doi:10.3171/spi.2006.5.1.9

    Article  PubMed  Google Scholar 

  26. Arun R, Dabke HV, Mehdian H (2011) Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction. Europ spine j off publtn Europ Spine Soc, Europ Spinal Deform Soc, Europ Sec Cervic Spine Res Soc 20:2252–2260. doi:10.1007/s00586-011-1894-3

    Article  Google Scholar 

Download references

Acknowledgments

The study was supported by the Hunan Province Institute of Science and Technology Fund (2009SK2012) and the Fundamental Research Funds for the Central Universities (2012QNZT126).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China

    Hong Qi Zhang, Jia Huang, Chao Feng Guo, Shao Hua Liu & Ming Xing Tang

Authors
  1. Hong Qi Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jia Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chao Feng Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shao Hua Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ming Xing Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hong Qi Zhang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, H.Q., Huang, J., Guo, C.F. et al. Two-level pedicle subtraction osteotomy for severe thoracolumbar kyphotic deformity in ankylosing spondylitis. Eur Spine J 23, 234–241 (2014). https://doi.org/10.1007/s00586-013-2867-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-013-2867-5

Keywords

Search

Navigation