Clin Orthop Surg.  2015 Sep;7(3):330-336. 10.4055/cios.2015.7.3.330.

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

• Kim KT
• Park DH
• Lee SH
• Lee JH

• KMID: 2234087
• DOI: http://doi.org/10.4055/cios.2015.7.3.330

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 31.9degrees +/- 11.7degrees with PSO, 14.3degrees +/- 8.4degrees with SPO, 38.3degrees +/- 12.7degrees with PVCR, and 19.3degrees +/- 7.1degrees 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.

Keyword

Ankylosing spondylitis; Osteotomy; Sagittal alignment

MeSH Terms

Adult
Aged
Female
Humans
Kyphosis/*complications/*surgery
Male
Middle Aged
Osteotomy/*adverse effects/*methods
Postoperative Complications
Retrospective Studies
Spondylitis, Ankylosing/*complications/*surgery
Treatment Outcome
Young Adult

Figure

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  Fig. 1 Type of deformity according to the location of apex.

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  Fig. 2 Diagram of the craniocervical range of motion.

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