Hip involvement negatively impact the postoperative radiographic outcomes after lumbar pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis-a retrospective study

Study Design: Retrospective study. Objectives: To analyze the change in acetabular anteversion (AA) after lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis who have already undergone total hip arthroplasty (THA). Methods: AS patients with thoracolumbar kyphosis following lumbar PSO from January 2005 to January 2020 were retrospectively reviewed. Only the patients performed with THA prior to the PSO were included. AA was measured on the full-length standing posterior-anterior radiographs using the ellipse method. Results: Twenty patients (34 hips) with a mean age of 36.8 years (range, 22 to 63 years) were included. After lumbar PSO, AA was reduced from 18.59° to 5.85° ( P < 0.001). Postoperative change in AA was correlated with the spinal deformity correction. Additionally, the change in AA postoperatively was correlated with pelvic incidence (PI) (R = 0.346, P = 0.045). Although the postoperative change in sagittal vertical axis (SVA) was larger in the patients after L2 or L3 PSO (153.97 mm vs 70.03 mm, P = 0.006), no difference was found in the postoperative change in AA (12.83° vs 10.96°, P = 0.540) compared with the patients following L1 PSO. Conclusions: AA was significantly decreased following lumbar PSO and the postoperative change in AA was correlated with the magnitude of spinal deformity correction. Notably, the effect of osteotomy level on the postoperative change in AA was limited in the AS patients underwent 1-level PSO.

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Can acetabular orientation be restored by lumbar pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis?

European Spine Journal ◽

10.1007/s00586-016-4709-8 ◽

2016 ◽

Vol 26 (7) ◽

pp. 1826-1832 ◽

Cited By ~ 10

Author(s):

Jun Hu ◽

Bang-ping Qian ◽

Yong Qiu ◽

Bin Wang ◽

Yang Yu ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Pedicle Subtraction Osteotomy ◽

Thoracolumbar Kyphosis ◽

Acetabular Orientation ◽

Lumbar Pedicle

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Can fusion to S1 maintain favorable surgical outcomes following one-level pedicle subtraction osteotomy in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis?

European Spine Journal ◽

10.1007/s00586-020-06538-w ◽

2020 ◽

Vol 29 (12) ◽

pp. 3028-3037

Author(s):

Ji-chen Huang ◽

Wei-yi Diao ◽

Bang-ping Qian ◽

Bin Wang ◽

Yang Yu ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Surgical Outcomes ◽

Pedicle Subtraction Osteotomy ◽

Thoracolumbar Kyphosis

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Pedicle Subtraction Osteotomy for Correction of Severe Thoracolumbar Kyphosis in Ankylosing Spondylitis

Orthopaedic Surgery ◽

10.1111/os.12124 ◽

2014 ◽

Vol 6 (3) ◽

pp. 257-258 ◽

Cited By ~ 4

Author(s):

Zhen Liu ◽

Yong Qiu ◽

Ze-zhang Zhu ◽

Bang-ping Qian ◽

Jun Qiao ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Pedicle Subtraction Osteotomy ◽

Thoracolumbar Kyphosis

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Radiographic findings for surgery-related complications after pedicle subtraction osteotomy for thoracolumbar kyphosis in 230 patients with ankylosing spondylitis

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine191355 ◽

2020 ◽

Vol 33 (3) ◽

pp. 366-372

Author(s):

Keun-Ho Lee ◽

Ki-Tack Kim ◽

Yong-Chan Kim ◽

Joong-Won Lee ◽

Kee-Yong Ha

Keyword(s):

Ankylosing Spondylitis ◽

Pedicle Screws ◽

Pedicle Subtraction Osteotomy ◽

Delayed Union ◽

Mechanical Failure ◽

Technical Failure ◽

Thoracolumbar Kyphosis ◽

Radiographic Findings ◽

Coronal Imbalance ◽

Surgical Technical

OBJECTIVEThe purpose of this study was to investigate the rate of and the risk factors for surgery-related complications demonstrated on radiography after pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis in patients with ankylosing spondylitis (AS).METHODSThe authors retrospectively reviewed the medical records of 230 consecutive patients with thoracolumbar kyphosis due to AS who had undergone 1-level PSO at a single institution in the period from 2010 to 2017. The causes of surgery-related complications were divided into two types: surgical/technical failure and mechanical failure.RESULTSThe patients consisted of 20 women and 210 men, with an average age of 43.4 years. The average follow-up period was 39.0 months. The preoperative sagittal vertical axis was 18.5 ± 69.3 cm, which improved to 4.9 ± 4.6 cm after PSO. Of the 77 patients (33.5%) who experienced minor or major surgery-related complications, 56 had complications related to surgical/technical failure (overall incidence 24.3%) and 21 had complications related to mechanical failure (overall incidence 9.1%). Fourteen patients (6.1%) underwent reoperation. However, among the 77 patients with complications, the rate of revision surgery was 18.2%. The most common radiological complications were as follows: sagittal translation in 24 patients, coronal imbalance in 20, under-correction in 8, delayed union in 8, and distal junctional failure and kyphosis in 8. The most common causes of reoperation were coronal imbalance in 4 patients, symptomatic malposition of pedicle screws in 3, and distal junctional failure in 3. Delayed union was statistically correlated with posterior sagittal translation (p = 0.007).CONCLUSIONSPSO can provide acceptable radiographic outcomes for the correction of thoracolumbar kyphosis in patients with AS. However, a high incidence of surgery-related complications related to mechanical failure and surgical technique can develop. Thorough radiographic investigation before and during surgery is needed to determine whether complete ossification occurs along the anterior and posterior longitudinal ligaments of the spine.

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