TY - JOUR
T1 - Spinal pseudarthrosis in advanced ankylosing spondylitis with sagittal plane deformity
T2 - Clinical characteristics and outcome analysis
AU - Kim, Ki Tack
AU - Lee, Sang Hun
AU - Suk, Kyung Soo
AU - Lee, Jung Hee
AU - Im, Yang Jin
PY - 2007/7
Y1 - 2007/7
N2 - STUDY DESIGN. A retrospective study of consecutive ankylosing spondylitis (AS) patients with spinal pseudarthrosis. OBJECTIVES. To review the clinical characteristics and assess the outcomes of surgical treatment of spinal pseudarthrosis in advanced AS patients with sagittal plane deformity. SUMMARY OF BACKGROUND DATA. There have been several reports describing the clinical findings of spinal pseudarthrosis in AS. However, few have studied the outcomes of surgical treatment of spinal pseudarthrosis with sagittal plane deformity in advanced AS patients. METHODS. A total of 19 destructive vertebral lesions in 12 patients were reviewed. We performed Smith-Petersen osteotomy (SPO) at the same level for correction of sagittal plane deformity and anterior interbody fusion (AIF) for repair of pseudarthrosis. Pedicle subtraction osteotomy (PSO) was performed additionally at the lumbar spine in six severe kyphotic patients. Outcome variables included radiographic measurement from preoperative, immediate postoperative and follow-up films (mean, 51 months; range, 35-108 months), and clinical assessment using visual analog scale for back pain and the modified SRS outcome instruments satisfaction domain and the review of postoperative complications. RESULTS. Clinical characteristics including trauma and inflammatory reaction were variable. The mean time for radiographic union of pseudarthrosis was 4.2 months (range, 2.5-6 months). Average correction of segmental kyphosis with SPO at the level of pseudarthrosis was 20.9° (range, 5°-34°) and 26.3° (range, 20°-32°) with lumbar PSO. Mean sagittal imbalance had improved 15.2 cm (range, 6.7-34.7 cm) at the last follow-up. All 12 patients had improvement of pain and neurologic deficit. The mean visual analog scale for pain had improved 4.8 (range, 4-7). The mean SRS score for patient satisfaction at the last follow-up was 4.6 of a possible 5. There were 7 cases of complications, including 3 cases of intraoperative dural tear, 2 cases of postoperative radiculopathy, and 1 case of wound infection. There was no permanent complication. CONCLUSIONS. SPO at the level of pseudarthrosis was a safe and effective technique to correct sagittal imbalance without vascular complication. Surgical repair of pseudarthrosis with AIF provided successful fusion and good clinical results. For patients with lumbar hypolordosis, additional PSO was effective in restoration of sagittal balance.
AB - STUDY DESIGN. A retrospective study of consecutive ankylosing spondylitis (AS) patients with spinal pseudarthrosis. OBJECTIVES. To review the clinical characteristics and assess the outcomes of surgical treatment of spinal pseudarthrosis in advanced AS patients with sagittal plane deformity. SUMMARY OF BACKGROUND DATA. There have been several reports describing the clinical findings of spinal pseudarthrosis in AS. However, few have studied the outcomes of surgical treatment of spinal pseudarthrosis with sagittal plane deformity in advanced AS patients. METHODS. A total of 19 destructive vertebral lesions in 12 patients were reviewed. We performed Smith-Petersen osteotomy (SPO) at the same level for correction of sagittal plane deformity and anterior interbody fusion (AIF) for repair of pseudarthrosis. Pedicle subtraction osteotomy (PSO) was performed additionally at the lumbar spine in six severe kyphotic patients. Outcome variables included radiographic measurement from preoperative, immediate postoperative and follow-up films (mean, 51 months; range, 35-108 months), and clinical assessment using visual analog scale for back pain and the modified SRS outcome instruments satisfaction domain and the review of postoperative complications. RESULTS. Clinical characteristics including trauma and inflammatory reaction were variable. The mean time for radiographic union of pseudarthrosis was 4.2 months (range, 2.5-6 months). Average correction of segmental kyphosis with SPO at the level of pseudarthrosis was 20.9° (range, 5°-34°) and 26.3° (range, 20°-32°) with lumbar PSO. Mean sagittal imbalance had improved 15.2 cm (range, 6.7-34.7 cm) at the last follow-up. All 12 patients had improvement of pain and neurologic deficit. The mean visual analog scale for pain had improved 4.8 (range, 4-7). The mean SRS score for patient satisfaction at the last follow-up was 4.6 of a possible 5. There were 7 cases of complications, including 3 cases of intraoperative dural tear, 2 cases of postoperative radiculopathy, and 1 case of wound infection. There was no permanent complication. CONCLUSIONS. SPO at the level of pseudarthrosis was a safe and effective technique to correct sagittal imbalance without vascular complication. Surgical repair of pseudarthrosis with AIF provided successful fusion and good clinical results. For patients with lumbar hypolordosis, additional PSO was effective in restoration of sagittal balance.
KW - Ankylosing spondylitis
KW - Pseudarthrosis
KW - Sagittal plane deformity
UR - http://www.scopus.com/inward/record.url?scp=34447314748&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34447314748&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e318074c3ce
DO - 10.1097/BRS.0b013e318074c3ce
M3 - Article
C2 - 17621212
AN - SCOPUS:34447314748
SN - 0362-2436
VL - 32
SP - 1641
EP - 1647
JO - Spine
JF - Spine
IS - 15
ER -