The Sagittal Parameters and Efficacy of Pedicle Subtraction Osteotomy in Patients with Ankylosing Spondylitis and Kyphosis Under Different Lumbar Sagittal Morphologies

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Abstract

Objective

This study aimed to compare the changes in sagittal parameters and the efficacy of pedicle subtraction osteotomy (PSO) in patients with ankylosing spondylitis (AS) and kyphosis under different lumbar sagittal morphologies and to explore the effect of sagittal morphology on the selection of PSO levels.

Methods

A total of 24 patients with AS and thoracolumbar kyphosis (TK) who were admitted to the First Affiliated Hospital of Xinjiang Medical University between 2008 and 2019 were enrolled in this study. They were divided into two groups: a lumbar lordosis group (n = 14) and a lumbar kyphosis group (n = 10). Changes in sagittal parameters, lumbar Japanese Orthopaedic Association (JOA) scores, and visual analog scale (VAS) scores for lumbar pain before and after operation were compared between the two groups to evaluate postoperative efficacy.

Results

The preoperative lumbar lordosis (LL) was −29.29 ± 5.40 (lordosis) and 13.50 ± 3.65 (kyphosis) ( P < 0.01), and the preoperative sagittal vertical axis (SVA) was 171.35 ± 25.46 (lordosis) and 223.58 ± 21.87 (kyphosis) ( P < 0.01). Preoperative global kyphosis (GK) was 75.71 ± 5.26 (lordosis) and 86.30 ± 10.32 (kyphosis) ( P < 0.05). All patients in the lordosis group underwent PSO surgery at the twelfth thoracic vertebra (T12) or the first lumbar spinal vertebra (L1), while all patients in the kyphosis group underwent the surgery at the second or third lumbar spinal vertebra (L2 or L3). The differences in postoperative GK, LL, and SVA between the two groups were not significant ( P > 0.05). The JOA scores of the two groups increased from 13.00 ± 0.83 (lordosis) and 11.30 ± 0.93 (kyphosis) before surgery to 21.00 ± 0.67 and 19.70 ± 0.60 after surgery ( P < 0.05).

Conclusion

Preoperative lumbar sagittal morphology needs to be considered when selecting the optimal osteotomy plane. An osteotomy can achieve the greatest success in patients with lumbar kyphosis at L2/L3; for patients with lumbar lordosis, it can achieve satisfactory outcomes at T12/L1.

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Most cited references 32

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Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position.

J. Dimnet, Pierre Roussouly, Sohrab Gollogly … (2005)

A prospective radiographic study of 160 volunteers without symptoms of spinal disease was conducted. The objective of this study was to describe, quantify, and classify common variations in the sagittal alignment of the spine, sacrum, and pelvis. Previous publications have documented the high degree of variability in the sagittal alignment of the spine. Other studies have suggested that specific changes in alignment and the characteristics of the lumbar lordosis are responsible for degenerative changes and symptomatic back pain. In the course of this study, anteroposterior and lateral radiographs of 160 volunteers in a standardized standing position were taken. A custom computer application was used to analyze the alignment of the spine and pelvis on the lateral radiographs. A four-part classification scheme of sagittal morphology was used to classify each patient. Reciprocal relationships between the orientation of the sacrum, the sacral slope, the pelvic incidence, and the characteristics of the lumbar lordosis were evident. The global lordotic curvature, lordosis tilt angle, position of the apex, and number or lordotic vertebrae were determined by the angle of the superior endplate of S1 with respect to the horizontal axis. Understanding the patterns of variation in sagittal alignment may help to discover the association between spinal balance and the development of degenerative changes in the spine.

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Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves

C Marty, J Legaye, G. Duval-Beaup�re … (1998)

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Osteotomies/spinal column resections in adult deformity.

Meric Enercan, Cagatay Ozturk, Sinan Kahraman … (2013)

Osteotomies may be life saving procedures for patients with rigid severe spinal deformity. Several different types of osteotomies have been defined by several authors. To correct and provide a balanced spine with reasonable amount of correction is the ultimate goal in deformity correction by osteotomies. Selection of osteotomy is decided by careful preoperative assessment of the patient and deformity and the amount of correction needed to have a balanced spine. Patient's general medical status and surgeon's experience levels are the other factors for determining the ideal osteotomy type. There are different osteotomy options for correcting deformities, including the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR) providing correction of the sagittal and multiplanar deformity. SPO refers to a posterior column osteotomy in which the posterior ligaments and facet joints are removed and a mobile anterior disc is required for correction. PSO is performed by removing the posterior elements and both pedicles, decancellating vertebral body, and closure of the osteotomy by hinging on the anterior cortex. BDBO is an osteotomy that aims to resect the disc with its adjacent endplate(s) in deformities with the disc space as the apex or center of rotational axis (CORA). VCR provides the greatest amount of correction among other osteotomy types with complete resection of one or more vertebral segments with posterior elements and entire vertebral body including adjacent discs. It is also important to understand sagittal imbalance and the surgeon must consider global spino-pelvic alignment for satisfactory long-term results. Vertebral osteotomies are technically challenging but effective procedures for the correction of severe adult deformity and should be performed by experienced surgeons to prevent catastrophic complications.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Gen Med

Journal ID (iso-abbrev): Int J Gen Med

Journal ID (publisher-id): ijgm

Journal ID (pmc): ijgm

Title: International Journal of General Medicine

Publisher: Dove

ISSN (Electronic): 1178-7074

Publication date (Electronic): 05 February 2021

Publication date Collection: 2021

Volume: 14

Pages: 361-370

Affiliations

[1 ]Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University , Urumqi, 830054, People’s Republic of China

Author notes

Correspondence: Qiang Deng Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University , No. 137 of Liyushan South Road, Xinshi District, Urumqi, 830054, People’s Republic of ChinaTel +86 13325636562 Email dengqiang_abc@163.com

Author information

Qiang Deng http://orcid.org/0000-0002-1528-4750

Article

Publisher ID: 292894

DOI: 10.2147/IJGM.S292894

PMC ID: 7873030

PubMed ID: 33574694

SO-VID: 96ebd5d2-2299-478a-9ec4-edba0d22896e

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 19 November 2020

Date accepted : 14 January 2021

Page count

Figures: 5, Tables: 6, References: 32, Pages: 10

Funding

Funded by: Fluoride-stained Cells Project;

This study was funded by the Research on TGF-β2 in regulating the apoptotic signaling pathways of Fluoride-stained Cells Project (No.2018D01C158). The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

The Sagittal Parameters and Efficacy of Pedicle Subtraction Osteotomy in Patients with Ankylosing Spondylitis and Kyphosis Under Different Lumbar Sagittal Morphologies

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Abstract

Objective

Methods

Results

Conclusion

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The International Journal of Person Centered Medicine

Most cited references 32

Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position.

Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves

Osteotomies/spinal column resections in adult deformity.

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