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Two-Level Osteotomy for the Corrective Surgery of Severe Kyphosis From Ankylosing Spondylitis

A Retrospective Series

Zhong, Woquan MD; Chen, Zhongqiang MD; Zeng, Yan MD; Sun, Chuiguo MD; Li, Weishi MD; Qi, Qiang MD; Guo, Zhaoqing MD

doi: 10.1097/BRS.0000000000003095
DEFORMITY
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Study Design. Retrospective study.

Objective. To describe the treatment results of patients with severe ankylosing spondylitis (AS) kyphosis who underwent two-level osteotomy and correction surgery.

Summary of Background Data. The best solution for the fixed kyphotic deformity of AS is corrective osteotomy. Many osteotomy options are available: pedicle subtraction osteotomy (PSO), Smith-Peterson osteotomy (SPO), and vertical column resection (VCR). These procedures all provide multiplanar deformity correction. Nevertheless, when the AS deformity is severe, an additional osteotomy site to get more correction, achieve more ideal, and smooth curvature of the spine than single osteotomy.

Methods. From May, 2008 to August, 2016, 19 patients of severe AS kyphosis underwent two-level spinal osteotomy and correction surgery. The patients had an average kyphosis angle greater than 90°. The radiological features and clinical evaluation, including Oswestry Disability Index (ODI), visual analog scale (VAS), and Scoliosis Research Society (SRS)-22 components were assessed before surgery and at follow-up. The patients underwent either one-level PSO combined with one-level SPO (n = 9) or two-level PSO (n = 10).

Results. The height was increased after surgery in all patients (P < 0.05). The median follow-up was 24 months. The kyphosis angle improved from 92.0 ± 16.6° to 30.0 ± 17.2°. The chin-brow vertical angle improved from 37.6 ± 19.2° to –0.6 ± 2.5°. The sacral slope improved from 3.9 ± 11.8° to 21.7 ± 7.4°. Sagittal imbalance improved from 241.4 ± 115.3 mm to 74.6 ± 48.5 mm (P < 0.05). Lumbar lordosis improved from –3.9 ± 20.8° to 29.4 ± 14.1° (all P < 0.05). There were significant improvements in the ODI, VAS, and all components of SRS-22 (all P < 0.05). All patients with pseudarthrosis (n = 5) underwent PSO + SPO and achieved satisfactory results. Six complications were observed perioperatively, but without permanent sequelae.

Conclusion. Two-level osteotomy and correction procedure can achieve satisfactory results in severe AS kyphosis. PSO + SPO could be a good option for patients with pseudarthrosis because of relatively easier and faster operation.

Level of Evidence: 4

Two-level osteotomy (pedicle subtraction osteotomy [PSO] + PSO and PSO + Smith-Peterson osteotomy [SPO]) and correction procedure achieved satisfactory results in 19 patients of severe ankylosing spondylitis (AS) kyphosis, including corrective effection and clinical symptomes. PSO + SPO could be a good option for patients with pseudarthrosis because of relatively easier and faster operation.

Department of Orthopaedics, Peking University Third Hospital, Beijing, China.

Address correspondence and reprint requests to Yan Zeng, MD, Department of Orthopaedics, Peking University Third Hospital, Beijing, China; E-mail: sailor_puth@163.com

Received 23 January, 2019

Revised 29 March, 2019

Accepted 8 April, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.