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Qiao M, Qian BP, Qiu Y, Song CY, Lu JS, Wang KY. Coronal deformity in ankylosing spondylitis with concomitant thoracolumbar kyphosis: patterns, manifestations and surgical strategies. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2935-2951. [PMID: 38869649 DOI: 10.1007/s00586-024-08357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/25/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE To evaluate different patterns of coronal deformity secondary to ankylosing spondylitis (AS), to propose relevant treatment strategies, and to assess efficacy of asymmetrical pedicle subtraction osteotomy (APSO). METHODS Coronal deformity was defined as coronal Cobb angle over 20º or coronal balance distance (CBD) more than 3 cm. 65 consecutive AS patients with concomitant coronal and sagittal deformity who underwent PSO were included. The average follow-up time was 40.4 months. Radiographic evaluation included coronal Cobb angle and CBD. Furthermore, sagittal parameters were used to assess magnitude and maintenance of kyphosis correction. RESULTS Based on curve characteristics, coronal deformity caused by AS included four different radiologic patterns: Pattern I: lumbar scoliosis; Pattern II: C-shaped thoracolumbar curve; Pattern III: trunk shift without major curve; Pattern IV: proximal thoracic scoliosis. APSO was performed for patients in Pattern I to III while conventional PSO was applied for patients in Pattern IV. Significant improvement in all the sagittal parameters were noted in 65 patients without obvious correction loss at the last follow-up. Besides, significant and sustained correction of coronal mal-alignment was identified in 59 APSO-treated patients. Rod fracture occurred in four cases and revision surgery was performed for one case. CONCLUSION According to radiologic manifestations, coronal deformity caused by AS could be categorized into four patterns. APSO proved to be a feasible and effective procedure for correction of Pattern I to III patients. Coronal deformity pattern, apex location, sagittal profile of lumbar spine and preoperative hip function should be considered for osteotomy level selection in APSO.
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Affiliation(s)
- Mu Qiao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Bang-Ping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Chen-Yu Song
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Jing-Shun Lu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Kai-Yang Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
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Luan H, Xie X, Sheng W, Deng Q. Surgical strategy of ankylosing spondylitis combined with cervical fracture: a retrospective study. Asian J Surg 2024; 47:3301-3303. [PMID: 38614845 DOI: 10.1016/j.asjsur.2024.03.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024] Open
Affiliation(s)
- Haopeng Luan
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Xuyang Xie
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Qiang Deng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China.
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Huneidi M, Bailly N, Farah K, May A, Arnoux PJ, Fuentes S. Iatrogenic vertebral fracture in ankylosed spine during liver transplantation: a case report and biomechanical study using finite element method. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1332-1339. [PMID: 38172415 DOI: 10.1007/s00586-023-08103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The occurrence of an iatrogenic vertebral fracture during non-spinal digestive surgery is an exceptional event that has not been previously documented. Our study aims to explain the occurrence of this fracture from a biomechanical perspective, given its rarity. Using a finite element model of the spine, we will evaluate the strength required to induce a vertebral fracture through a hyperextension mechanism, considering the structure of the patient's spine, whether it is ossified or healthy. METHODS A 70-year-old patient was diagnosed T12 fracture during a liver transplantation on ankylosed spine. We use a finite element model of the spine. Different mechanical properties were applied to the spine model: first to a healthy spine, the second to a osteoporotic ossified spine. The displacement and force imposed at the Sacrum, the time and location of fractures initiation were recorded and compared between the two spine conditions. RESULTS A surgical treatment is done associating decompression with posterior fixation. After biomechanical study, we found that the fracture initiation occurred for the ossified spine after a sacrum displacement of 29 mm corresponding to an applied force of 65 N. For the healthy spine it occurred at a sacrum displacement of 52 mm corresponding to an applied force of 350 N. CONCLUSION The force required to produce a type B fracture in an ankylosed spine is 5 times less than in a healthy spine. These data enable us to propose several points of management to avoid unexpected complications with ankylosed spines during surgical procedures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Maxime Huneidi
- Département de Chirurgie Rachidienne, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, CHU Bordeaux, France.
| | - Nicolas Bailly
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR- Université de la Méditerranée, 13916, Marseille Cedex 20, France
| | - Kaissar Farah
- Département de Neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Adrien May
- Département de Neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Pierre-Jean Arnoux
- Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR- Université de la Méditerranée, 13916, Marseille Cedex 20, France
| | - Stéphane Fuentes
- Département de Neurochirurgie, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, 264 Rue Saint Pierre, 13005, Marseille, France
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Lv X, Nuertai Y, Wang Q, Zhang D, Hu X, Liu J, Zeng Z, Huang R, Huang Z, Zhao Q, Li W, Zhang Z, Gao L. Multilevel Pedicle Subtraction Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Clinical Effect and Biomechanical Evaluation. Neurospine 2024; 21:231-243. [PMID: 38317554 PMCID: PMC10992630 DOI: 10.14245/ns.2347118.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/08/2023] [Accepted: 12/16/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To compare the clinical outcomes and biomechanical characteristics of 1-, 2-, and 3-level pedicle subtraction osteotomy (PSO), and establish selection criteria based on preoperative radiographic parameters. METHODS Patients undergone PSO to treat ankylosing spondylitis from February 2009 to May 2019 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled. According to the quantity of osteotomy performed, the participants were divided into group A (1-level PSO, n = 24), group B (2-level PSO, n = 19), and group C (3-level PSO, n = 11). Clinical outcomes were assessed before surgery and at the final follow-up. Comparisons of the radiographic parameters and quality-of-life indicators were performed among and within these groups, and the selection criteria were established by regression. Finite element analysis was conducted to compare the biomechanical characteristics of the spine treated with different quantity of osteotomies under different working conditions. RESULTS Three-level PSO improved the sagittal parameters more significantly, but resulted in longer operative time and greater blood loss (p < 0.05). Greater stress was found in the proximal screws and proximal junction area of the vertebra in the model simulating 1-level PSO. Larger stress of screws and vertebra was observed at the distal end in the model simulating 3-level PSO. CONCLUSION Multilevel PSO works better for larger deformity correction than single-level PSO by allowing greater sagittal parameter correction and obtaining a better distribution of stress in the hardware construct, although with longer operation time and greater blood loss. Three-level osteotomy is recommended for the patients with preoperative of global kyphosis > 85.95°, T1 pelvic angle > 62.3°, sagittal vertical alignment > 299.55 mm, and pelvic tilt+ chin-brow vertical angle > 109.6°.
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Affiliation(s)
- Xin Lv
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yelidana Nuertai
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiwei Wang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Di Zhang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xumin Hu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiabao Liu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ziliang Zeng
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Renyuan Huang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhihao Huang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiancheng Zhao
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenpeng Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhilei Zhang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liangbin Gao
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Yin W, Zheng G, Zhang W, Zhai Y, Li H, Sun L, Wang K, Jiang J, Hua Z, Cui X, Yu H. A new mathematical model for evaluating surface changes in the mid-abdominal sagittal plane after two-level pedicle reduction osteotomy in patients with ankylosing spondylitis. BMC Surg 2024; 24:38. [PMID: 38281928 PMCID: PMC11370221 DOI: 10.1186/s12893-023-02285-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/02/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The purpose of this study was to create a mathematical model to precalculate the acreage change in the abdominal median sagittal plane (ac-AMSP) of patients with ankylosing spondylitis (AS) for whom two-level pedicle subtraction osteotomy (PSO) was planned. METHODS A single-centre retrospective review of prospectively collected data was conducted among 11 adults with AS. Acreage of the abdominal median sagittal plane (a-AMSP) was performed. The distances and angles between the osteotomy apexes, anterosuperior edge of T12, xiphoid process, superior edge of the pubis, and anterosuperior corner of the sacrum were measured on preoperative thoracolumbar computed tomography. A mathematical model was created using basic trigonometric functions in accordance with the abdominal parameters. Planned osteotomized vertebra angles (POVAs) were substituted into the mathematical model, and the predictive ac-AMSP (P-AC) was obtained. A paired sample t test was performed to determine the differences between the P-AC and actual ac-AMSP (A-AC) and between the predictive acreage change rate (P-CR) and actual acreage change rate (A-CR). RESULTS The mean age and GK were 44.4 ± 8.99 years and 102.9° ± 19.17°, respectively. No significant difference exists between A-CR and P-CR via mathematical modeling (p > 0.05). No statistically significant difference existed between POVA and actual osteotomized vertebra angles (AOVA) (p > 0.05). A statistically significant difference was observed between preoperative and postoperative measurements of LL, SVA, and GK variables (p < 0.001). CONCLUSIONS The novel mathematical model was reliable in predicting the ac-AMSP in AS patients undergoing two-level PSO.
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Affiliation(s)
- Wen Yin
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Guohui Zheng
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Wei Zhang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Yunlei Zhai
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Haijiang Li
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Lele Sun
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Kangkang Wang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Jishi Jiang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Zikai Hua
- School of Mechatronics Engineering and Automation, Shanghai University, 333 Nanchen Road, Shanghai, 200072, China
| | - Xilong Cui
- School of Mechatronics Engineering and Automation, Shanghai University, 333 Nanchen Road, Shanghai, 200072, China.
| | - Haiyang Yu
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China.
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China.
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Lee JK, Hyun SJ, Kim KJ. Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets. Neurospine 2023; 20:1246-1255. [PMID: 38171292 PMCID: PMC10762390 DOI: 10.14245/ns.2346744.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 01/05/2024] Open
Abstract
Cervical spinal deformity (CSD) is a complex condition characterized by abnormal curvature and cervical spine alignment. It can lead to a multitude of symptoms, including chronic pain, neurological deficits, and functional impairments, severely impacting an individual's health-related quality of life (HRQoL). Surgical intervention is often necessary to address the deformity and alleviate symptoms, but optimal surgical strategies remain a topic of ongoing research and debate. This narrative review aims to provide an in-depth overview of the surgical management of CSD, focusing on optimizing patient outcomes and enhancing readers' understanding of the complexities involved. We begin by discussing the importance of preoperative assessment, including comprehensive radiographic evaluation and careful consideration of the global spinal alignment. The relationship between the cervical spine and the reciprocal changes that occur are explored to guide surgeons in their decision-making process. Furthermore, we delve into the selection of fusion levels, emphasizing the significance of identifying the primary driver of deformity. We review the current literature on optimal alignment targets and strategies to optimize surgical planning. By providing a comprehensive analysis of the surgical management of CSD, this review aims to enhance the readers' knowledge and assist surgeons in making informed decisions when planning and executing surgical interventions. Understanding the intricacies of CSD correction and the latest advancements in the field can ultimately improve patient outcomes and enhance HRQoL for individuals suffering from this challenging condition.
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Affiliation(s)
- Jae-Koo Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Zhai X, Li B, Chen K, Chen Z, Shao J, Chen K, Xu Q, Meng D, Fei Q, Jiang L, Bai Y, Li M. Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review. Orthop Surg 2023; 15:2872-2880. [PMID: 37735987 PMCID: PMC10622289 DOI: 10.1111/os.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Improving accuracy and safety of pedicle screw placement is of great clinical importance. Electronic conductivity device (ECD) can be a promising technique with features of affordability, portability, and real-time detection capabilities. This study aimed to validate the safety and effectiveness of a modified ECD. METHODS The ECD underwent a modification where six lamps of various colors, and it was utilized in a prospectively multicenter randomized controlled clinical trial involving 96 patients across three hospitals from June 2018 to December 2018. The trial incorporated a self-control randomization with an equal distribution of left or right side of vertebral pedicle among two groups: the free-hand group and the ECD group. A total of 496 pedicle screws were inserted, with 248 inserted in each group. The primary outcomes focused on the accuracy of pedicle screw placement and the frequency of intraoperative X-rays. Meanwhile, the secondary indicator measured the time required for pedicle screw placement. Results were presented as means ± SD. Paired samples t-test and χ2 -test were used for comparison. Furthermore, an updated review was conducted, which included studies published from 2006 onwards. RESULTS Baseline patient characteristics were recorded. The primary accuracy outcome revealed a 96.77% accuracy rate in the ECD group, compared to a 95.16% accuracy rate in the free-hand group, with no significant differences noted. In contrast, ECD demonstrated a significant reduction in radiation exposure frequency when compared to the free-hand group (1.11 ± 0.32 vs. 1.30 ± 0.53; p < 0.001), resulting in a 14.6% reduction. Moreover, ECD displayed a decrease of 30.38% in insertion time (70.88 ± 30.51 vs. 101.82 ± 54.00 s; p < 0.001). According to the results of the 21 studies, ECD has been utilized in various areas of the spine such as the atlas, thoracic and lumbar spine, as well as sacral 2-alar-iliac. The accuracy of ECD ranged from 85% to 100%. CONCLUSION The prospectively randomized trial and the review indicate that the use of ECD presents a secure and precise approach to the placement of pedicle screws, with the added benefit of reducing both procedure time and radiation exposure.
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Affiliation(s)
- Xiao Zhai
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Bo Li
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Kai Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Ziqiang Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Jie Shao
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Kai Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Qintong Xu
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Dehua Meng
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Qinming Fei
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Leisheng Jiang
- Spine Center, Xinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yushu Bai
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Ming Li
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
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Si G, Qiu W, Shen Q, Wang Y, Li W, Yu M, Wang Y. Mini-open Pedicle Subtraction Osteotomy versus Standard Posterior Approach for Ankylosing Spondylitis-related Spinal Kyphosis: A Comparative Study. Orthop Surg 2023; 15:2656-2664. [PMID: 37681279 PMCID: PMC10549849 DOI: 10.1111/os.13873] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Surgical strategy for spinal kyphosis in patients with ankylosing spondylitis (AS) has been challenging. Pedicle subtraction osteotomy (PSO) through a minimally invasive (MI) approach has been developed with promising clinical outcomes. We aimed to compare the effectiveness and safety of PSO via an MI approach and a standard posterior approach (SPA) for treating AS-related spinal kyphosis. METHODS A total of 41 patients with AS-related spinal kyphosis who underwent PSO through an MI approach (MI surgery [MIS] group: n = 25) or SPA (SPA group: n = 16) between January 2015 and July 2020 were retrospectively included. Spinopelvic parameters were evaluated before the surgery, immediately after the surgery, and at the 2-year follow-up. Clinical data including operative time, estimated blood loss, blood transfusion, level of fusion, incision length, bed rest period, length of hospitalization, and surgical complications were compared between the two groups. The Scoliosis Research Society outcomes instrument-22 (SRS-22) was administered to assess patients' quality of life at the latest follow-up. Comparisons between the two groups were performed using independent sample t-test or Chi-square test. RESULTS Characteristics and baseline kyphosis of the two groups were matched. At the 2-year follow-up, in the MIS group, the average correction values of the sagittal vertical axis and global kyphosis (GK) were 9.5 cm and 44.3°, respectively. Compared with the SPA group, the MIS group had similar correction values and correction losses after surgery. No obvious differences were observed in any radiographic parameters, except for GK, immediately after surgery and at the 2-year follow-up between the two groups (p > 0.05). The MIS group had a significantly shorter operative time, lesser blood loss, lesser transfusion volume, shorter fusion level, and lesser time to mobilization than did the SPA group. Higher average functional activity scores of SRS-22 were obtained in the MIS group than in the SPA group. CONCLUSION Mini-open PSO may be an effective alternative to the SPA for treating AS-related spinal kyphosis, with comparable correction effect, lesser surgical trauma and faster recovery. This comparative study may provide valuable guidance for surgical decision-making and patient counseling.
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Affiliation(s)
- Gao Si
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weipeng Qiu
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Peking University Health Science CenterBeijingChina
| | - Qixian Shen
- Peking University Health Science CenterBeijingChina
| | - Yongqiang Wang
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Miao Yu
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yu Wang
- Peking University First Hospital, Department of OrthopaedicsBeijingChina
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Zhang W, Yin W, Cui X, Chai Z, Zheng G, Ding Y, Wang H, Zhai Y, Yu H. Operative strategies for ankylosing spondylitis-related thoracolumbar kyphosis: focus on the cervical stiffness, coronal imbalance and hip involvement. BMC Musculoskelet Disord 2023; 24:723. [PMID: 37697276 PMCID: PMC10494390 DOI: 10.1186/s12891-023-06810-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Cervical stiffness, coronal imbalance and limited hip movement all play crucial roles in designing the corrective surgery for ankylosing spondylitis-related thoracolumbar kyphosis (AS-TLK). However, a comprehensive classification and tailored strategies for directing clinical work are lacking. This study aims to investigate the types and surgical strategies for AS-TLK that consider cervical stiffness, coronal imbalance and hip involvement as the key factors. METHODS 25 consecutive AS-TLK patients were divided into three types according to their accompanying features: Type I: with a flexible cervical spine; Type IIA: with a stiff cervical spine; Type IIB: with coronal imbalance; Type IIC: with limited hip movement. Type III is the mixed type with at least two conditions of Type II. Individual strategies were given correspondingly. Spinal-pelvic-femoral parameters were measured, Scoliosis Research Society outcome instrument-22 (SRS-22) was used and complications were recorded and analysed. RESULTS All patients (Type I 10, Type II 8 and Type III 7) underwent surgery successfully. 13 cases with 16 complications were recorded and cured. The patients were followed up for 24-65 months with an average of 33.0 ± 9.6 months. Both the sagittal and coronal parameters were corrected and decreased significantly (all, p < 0.05). SRS-22 scores showed a satisfactory outcome. CONCLUSION Thoracolumbar kyphosis secondary to ankylosing spondylitis are complex and variable. Considering the factors of cervical stiffness, coronal imbalance and hip involvement assists in making decisions individually and achieving a desired surgical result.
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Affiliation(s)
- Wei Zhang
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Wen Yin
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Xilong Cui
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Zihao Chai
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Guohui Zheng
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Ya Ding
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Hongliang Wang
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Yunlei Zhai
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Haiyang Yu
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China.
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China.
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Li W, Tong G, Cai B, Quan R. Analysis of the outcome of bi-vertebral transpedicular wedge osteotomy for correcting severe kyphotic deformity in ankylosing spondylitis. Medicine (Baltimore) 2023; 102:e34155. [PMID: 37390269 PMCID: PMC10313282 DOI: 10.1097/md.0000000000034155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/09/2023] [Indexed: 07/02/2023] Open
Abstract
To study the outcomes of bi-vertebral transpedicular wedge osteotomy in correcting severe kyphotic deformity in ankylosing spondylitis (AS). This retrospective study focused on all the patients who underwent thoracic and lumbar bi-vertebra transpedicular wedge osteotomy with pedicle screw internal fixation to treat their severe thoracolumbar kyphotic deformity of AS in our hospital from January 2014 to January 2020. The perioperative and operative data of each patient were collected and analyzed. A total of 21 male AS patients with severe kyphotic deformity were studied with a mean age of 42.2 ± 9.2 years. Intraoperatively, the mean operating time is 5.8 ± 1.6 hour with a mean blood loss of 725.5 ± 140.6 mL. The average postoperative correction of kyphosis reached 60.8o at 1 week after the surgery, which is significantly improved from preoperative presentation (P < .05), and stayed no significant change over the time during longer period of follow-ups (12-24 months) with the overall correction rate of 72.2%. Moreover, the postoperative changes in thoracic kyphosis (TK) angle, thoracolumbar kyphosis (TLK) angle, lumbar lordosis (LL) angle, maxilla-brow angle, as well as C2SVA and C7SVA sagittal balance were also significant, all of which enabled the patients to walk in upright position and sleep in the supine position with the improvements in other clinical symptoms. Bi-vertebral transpedicular wedge osteotomy of thoracic and lumbar vertebrae is a safe and effective method to restore the physiological curvature of the sagittal position of the spine and correct severe ankylosing deformity.
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Affiliation(s)
- Wei Li
- Department of Orthopedics, Jiangnan Hospital, Hangzhou, China
| | - Guojun Tong
- Department of Orthopedics, Jiangnan Hospital, Hangzhou, China
| | - Binbin Cai
- Department of Orthopedics, Jiangnan Hospital, Hangzhou, China
| | - Renfu Quan
- Department of Orthopedics, Jiangnan Hospital, Hangzhou, China
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11
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Hu Z, Zhong R, Zhao D, Wang F, Huang H, Jiang D, Zhang Z, Liang Y. Staged osteotomy in lateral position for the treatment of severe kyphotic deformity secondary to ankylosing spondylitis: a retrospective study. J Orthop Surg Res 2023; 18:417. [PMID: 37296482 DOI: 10.1186/s13018-023-03884-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Patients with severe kyphotic deformity (Cobb > 100°) secondary to ankylosing spondylitis (AS) occasionally cannot undergo corrective surgery in the prone position. Osteotomy in the lateral position might provide a possible solution. In this study, we aim to evaluate the clinical efficacy and safety of staged osteotomy in the lateral position for the treatment of AS-related severe kyphosis with a minimum of 2-year follow-up. METHODS In total, 23 patients who underwent staged osteotomy in the lateral position from October 2015 to June 2017 were analyzed. In the first stage of surgery, all but one patient underwent a single-level Ponte osteotomy, which was followed by a pedicle subtraction osteotomy in the second stage. Mean follow-up was 30.8 ± 4.6 months. Global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), osteotomized vertebra intervertebral angle (OVI), chin-brow vertical angle (CBVA), Oswestry Disability Index (ODI) score and Scoliosis Research Society-22 Patient Questionnaire (SRS-22) were all compared pre- and postoperation. RESULTS All kyphosis parameters were significantly improved (all P < 0.05). GK was corrected from 115.0 ± 13.4° to 46.5 ± 9.0° postoperatively, with a mean correction of 68.5°. SVA was improved from 21.2 ± 5.1 cm to 5.1 ± 1.8 cm postoperatively. After surgery, CBVA was adjusted from 64.1 ± 23.2° to 5.7 ± 10.6° and OVI was changed from 9.0 ± 2.7° to - 20.1 ± 5.6°. Both the ODI and SRS-22 showed substantial improvements (all P < 0.05). Four patients with mild complications were observed perioperatively. CONCLUSION In AS patients with severe kyphosis, satisfactory correction can be safely achieved with staged osteotomy in the lateral position, which can not only correct the sagittal imbalance of the spine with acceptable complications but also facilitate the placement of the intraoperative position.
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Affiliation(s)
- Zhengjun Hu
- Department of Spine Surgery, The Third People's Hospital of Chengdu, Southwest Jiaotong University, #82 Qinglong Street, Chengdu, 610031, Sichuan, China
| | - Rui Zhong
- Department of Spine Surgery, The Third People's Hospital of Chengdu, Southwest Jiaotong University, #82 Qinglong Street, Chengdu, 610031, Sichuan, China
| | - Deng Zhao
- Department of Spine Surgery, The Third People's Hospital of Chengdu, Southwest Jiaotong University, #82 Qinglong Street, Chengdu, 610031, Sichuan, China
| | - Fei Wang
- Department of Spine Surgery, The Third People's Hospital of Chengdu, Southwest Jiaotong University, #82 Qinglong Street, Chengdu, 610031, Sichuan, China
| | - Huaqiang Huang
- Department of Spine Surgery, The Third People's Hospital of Chengdu, Southwest Jiaotong University, #82 Qinglong Street, Chengdu, 610031, Sichuan, China
| | - Dengxu Jiang
- Department of Spine Surgery, The Third People's Hospital of Chengdu, Southwest Jiaotong University, #82 Qinglong Street, Chengdu, 610031, Sichuan, China
| | - Zhong Zhang
- Department of Spine Surgery, The Third People's Hospital of Chengdu, Southwest Jiaotong University, #82 Qinglong Street, Chengdu, 610031, Sichuan, China
| | - Yijian Liang
- Department of Spine Surgery, The Third People's Hospital of Chengdu, Southwest Jiaotong University, #82 Qinglong Street, Chengdu, 610031, Sichuan, China.
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Chen S, Li Z, Chen D, Cui H, Wang J, Li Z, Li X, Zheng Z, Zhan Z, Liu H. Piezo1-mediated mechanotransduction promotes entheseal pathological new bone formation in ankylosing spondylitis. Ann Rheum Dis 2023; 82:533-545. [PMID: 36543525 DOI: 10.1136/ard-2022-223428] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to identify the role of Piezo1-mediated mechanotransduction in entheseal pathological new bone formation and to explore the underlying molecular mechanism. METHODS Spinal ligament tissues were collected from 14 patients with ankylosing spondylitis (AS) and 14 non-AS controls and bulk RNA sequencing was conducted. Collagen antibody-induced arthritis models were established to observe pathological new bone formation. Pharmacological inhibition and genetic ablation of Piezo1 was performed in animal models to identify the essential role of Piezo1. Entheseal osteo-chondral lineage cells were collected and in vitro cell culture system was established to study the role and underlying mechanism of Piezo1 in regulation of chondrogenesis, osteogenesis and its own expression. RESULTS Piezo1 was aberrantly upregulated in ligaments and entheseal tissues from patients with AS and animal models. Pharmaceutical and genetic inhibition of Piezo1 attenuated while activation of Piezo1 promoted pathological new bone formation. Mechanistically, activation of CaMKII (Calcium/calmodulin dependent protein kinase II) signalling was found essential for Piezo1-mediated mechanotransduction. In addition, Piezo1 was upregulated by AS-associated inflammatory cytokines. CONCLUSION Piezo1-mediated mechanotransduction promotes entheseal pathological new bone formation through CaMKII signalling in AS.
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Affiliation(s)
- Siwen Chen
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Zihao Li
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Dongying Chen
- Deparment of Rheumatology and Immunology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Haowen Cui
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Jianru Wang
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Zemin Li
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Xiang Li
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Zhaomin Zheng
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
| | - Zhongping Zhan
- Deparment of Rheumatology and Immunology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Hui Liu
- Department of Spine Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Orthopaedics and Traumatology, Guangzhou, Guangdong, China
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Wang Y, Huang Y, Zheng G, Zhang X, Wang T, Qi D, Hu W, Xue C, Zhao Y, Mao K, Wang Z. Trans-intervertebral osteotomy classification of posterior spinal corrective osteotomy procedures via the intervertebral space. BRAIN & SPINE 2022; 3:101707. [PMID: 36685706 PMCID: PMC9845419 DOI: 10.1016/j.bas.2022.101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/01/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
•This is a diagnostic study for a classification for posterior spinal osteotomy procedures via the intervertebral space.•Proposed a novel classification with excellent reliability and validity, differ from the SRS-Schwab osteotomy classification.•Give a novel definition of "trans-intervertebral osteotomy" (TIO) for posterior spinal osteotomy procedures.•Thoroughly discussed about the histories of posterior spinal osteotomy procedures via the intervertebral space.•Systematically introduced the TIO technique with fine original schematics.
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Affiliation(s)
- Yan Wang
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China,Corresponding author.
| | - Yi Huang
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China,Nankai University School of Medicine, Nankai University, Tianjin, 300071, China
| | - GuoQuan Zheng
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Xuesong Zhang
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Tianhao Wang
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Dengbin Qi
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Wenhao Hu
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Chao Xue
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Yongfei Zhao
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Keya Mao
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
| | - Zheng Wang
- Department of Orthopedics, General Hospital of Chinese People's Liberation Army, Beijing, 100853, China
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Cheng J, Zhang S, Sheng W. Evaluation of preoperative calculation methods of osteotomy size in ankylosing spondylitis with thoracolumbar or lumbar kyphosis. BMC Musculoskelet Disord 2022; 23:1076. [PMID: 36482380 PMCID: PMC9733216 DOI: 10.1186/s12891-022-06043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To evaluate the accuracy of different preoperative calculation methods of osteotomy size in ankylosing spondylitis with thoracolumbar or lumbar kyphosis and analyze its clinical significance. METHODS Twenty-two cases of AS patients with thoracolumbar or lumbar kyphosis, from January 2015 to December 2018, who underwent one-level SPO surgery in our hospital, were retrospectively reviewed. The sagittal parameters were measured at pre-operation and last follow up using Surgimap software, and theoretical values of sagittal parameters were calculated according to pre-operative PI. The osteotomy angles of different methods were measured using Surgimap software. Paired t test was used to for the statistical analysis. RESULTS The mean follow-up time of all patients was 30.00 [Formula: see text] 3.56 months. The osteotomy sites were located at T12 in 3 cases, L1 in 6 cases, L2 in 9 cases, and L3 in 4 cases. Compared to pre-operative sagittal parameters, post-operative PT, SS, LL, and SVA were significantly improved (P [Formula: see text] 0.05). Compared to the OVA (46.57 [Formula: see text] 2.32 [Formula: see text]), there was a significantly larger angle predicted by Surgimap method (53.80 [Formula: see text] 9.79 [Formula: see text]), CAM-HA method (56.61 [Formula: see text] 8.58 [Formula: see text]), and HP-HA method (60.07 [Formula: see text] 13.58 [Formula: see text]), respectively (P [Formula: see text] 0.05). But no significant difference was found between the postoperative osteotomy angle and those of SFA method (51.24 [Formula: see text] 12.14 [Formula: see text]) and FBI method (48.08 [Formula: see text] 12.49 [Formula: see text]) (P [Formula: see text] 0.05). CONCLUSION For AS patients with thoracolumbar or lumbar kyphosis, the SFA method, FBI method, and Surgimap method can be used to predict the osteotomy angle precisely, however, considering the rationality of parameter settings and the operability, SFA method is relatively more suitable for such population.
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Affiliation(s)
- Jie Cheng
- grid.413390.c0000 0004 1757 6938Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000 Guizhou China
| | - Shuwen Zhang
- grid.410644.3Department of Orthopedic, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumchi, 830001 Xinjiang China
| | - Weibin Sheng
- grid.412631.3Department of Spine Surgery, the First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Avenue, Xinshi District, Urumqi, 830054 Xinjiang China
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Cervical rotational osteotomy for correction of axial deformity in a patient with ankylosing spondylitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3768-3775. [PMID: 36169729 DOI: 10.1007/s00586-022-07364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/05/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Severe cervical axial deformity associated with ankylosing spondylitis (AS) is rare in clinic, and there are little concerns about surgical treatment of axial deformity associated with AS. The case study aims to show the surgical technique to perform cervical rotational osteotomy. METHODS We present the case of a young AS patient whose neck was fixed in a left-rotational posture at 18°, requiring his trunk to be turned to the right to look forward visually. This made his gait appear to be limping, inconveniencing him with great difficulty. In order to correct this deformity, we performed a novel cervical rotational osteotomy through a one-stage posterior-anterior-posterior approach. Firstly, we performed laminectomies of C7 and T1, followed by a C7/T1 facetectomy with release of the bilateral C8 nerve roots. Next, we performed C7/T1 discectomy, bony resection of the lateral body and uncovertebral joints. The head of the patient was then rotated manually, so that both his face and torso were simultaneously facing frontward. Finally, rods spanning the screws from C6 to T2 were fixed. RESULTS Postoperatively, the patient's axial malalignment was significantly improved, and he was able to walk normally. Surgical outcomes were well maintained at a 3-year follow-up. CONCLUSION Through this case, we hope to draw the attention to spinal axial deformity and provide a reference point in the surgical treatment of spinal axial deformity.
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Luo J, Yang K, Yang Z, Feng C, Li X, Luo Z, Tao H, Duan C, Wu T. Optimal immediate sagittal alignment for kyphosis in ankylosing spondylitis following corrective osteotomy. Front Surg 2022; 9:975026. [PMID: 36132199 PMCID: PMC9483024 DOI: 10.3389/fsurg.2022.975026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To investigate the optimal immediate sagittal alignment of kyphosis in ankylosing spondylitis (AS) following corrective osteotomy. Methods Seventy-seven AS patients who underwent osteotomy were enrolled. Radiographic parameters, including global kyphosis (GK), lumbar lordosis (LL), T1 spinopelvic inclination (T1SPI), sagittal vertical axis (SVA), T1 pelvic angle (TPA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and PI and LL mismatch (PI–LL), were collected. The clinical outcome was evaluated using the Scoliosis Research Society-22 (SRS-22) questionnaire and Oswestry Disability Index (ODI). At the final follow-up, SVA > 5 cm was regarded as sagittal imbalance, and a total ODI ≤ 20 or total SRS-22 score ≥4 was considered to indicate a good clinical outcome. Results Seventy-seven patients with an average age of 37.4 ± 8.6 years were followed up for 29.4 ± 4.2 months. At the final follow-up, GK, LL, PT, SS, TPA, and T1SPI showed some degree of correction loss (P < 0.05). The follow-up parameters could be predicted with the immediate postoperative parameters through their linear regression equation (P < 0.05). The postoperative immediate T1SPI, TPA, SVA, and PI were also highly correlated with the clinical outcome (ODI and/or SRS-22) at the final follow-up (P < 0.05). Based on the relationship, the optimal immediate sagittal alignment for obtaining good clinical outcome was determined: T1SPI ≤ 0.9°, TPA ≤ 31.5°, and SVA ≤ 9.3cm. AS patients with PI ≤ 49.2° were more likely to achieve the optimal alignment and obtained lower ODI and a lower incidence of sagittal imbalance than those with PI > 49.2° at the final follow-up (P < 0.05). Conclusion Postoperative immediate parameters could be used to predict the final follow-up parameters and clinical outcome. The optimal postoperative immediate sagittal alignment of AS patients was T1SPI ≤ 0.9°, TPA ≤ 31.5°, and SVA ≤ 9.3 cm, providing a reference for kyphosis correction and a means for clinical outcome evaluation. Patients with a lower PI (≤49.2°) were more likely to achieve optimal alignment and obtain satisfactory clinical outcomes.
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Affiliation(s)
- Jianzhou Luo
- Department of Orthopaedics, Shenzhen University General Hospital, Shenzhen, China
| | - Kai Yang
- Department of Orthopaedics, Xi’an Red Cross Hospital, Xi’an, China
| | - Zili Yang
- Department of Orthopaedics, Shenzhen University General Hospital, Shenzhen, China
| | - Chaoshuai Feng
- Department of Orthopaedics, Xi’an Red Cross Hospital, Xi’an, China
| | - Xian Li
- Department of Orthopaedics, Shenzhen University General Hospital, Shenzhen, China
| | - Zhenjuan Luo
- Department of Orthopaedics, Shenzhen University General Hospital, Shenzhen, China
| | - Huiren Tao
- Department of Orthopaedics, Shenzhen University General Hospital, Shenzhen, China
| | - Chunguang Duan
- Department of Orthopaedics, Shenzhen University General Hospital, Shenzhen, China
| | - Tailin Wu
- Department of Orthopaedics, Shenzhen University General Hospital, Shenzhen, China
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
- Correspondence: Tailin Wu
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Luan H, Liu K, Kahaer A, Wang Y, Sheng W, Maimaiti M, Guo H, Deng Q. Pedicle subtraction osteotomy for the corrective surgery of ankylosing spondylitis with thoracolumbar kyphosis: experience with 38 patients. BMC Musculoskelet Disord 2022; 23:731. [PMID: 35907844 PMCID: PMC9338567 DOI: 10.1186/s12891-022-05693-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the sagittal parameters and clinical outcome of pedicle subtraction osteotomy (PSO) for the treatment of ankylosing spondylitis (AS) combined with thoracolumbar kyphosis. METHODS The clinical data of 38 patients with AS combined with thoracolumbar kyphosis who underwent PSO were enrolled and divided into the lumbar lordosis group and the lumbar kyphosis group according to the preoperative sagittal morphology. They were subdivided into the lumbar lordosis T12 group, lordosis L1 group, kyphosis L2 group, and kyphosis L3 group. The spine sagittal parameters were compared between the preoperative and the postoperative. Outcome evaluation was performed by the Japanese Orthopedic Association (JOA) score, visual analogue scale (VAS), and the Oswestry Disability Index (ODI). RESULTS A total of 38 patients with AS combined with thoracolumbar kyphosis were successfully treated by PSO, with a mean follow-up time of 26.9 ± 11.9 months. There were 30 males and 8 females with a mean age of 41.6 ± 7.1 years. Twenty patients consisted in the lumbar lordosis group and 18 patients in the lumbar kyphosis group. GK, SVA, and CBVA were improved significantly (P < 0.05) at the final follow-up between the lumbar lordosis T12 group and the L1 group. Patients in the lumbar kyphosis L2 group and L3 group all received satisfactory, including LL, GK, and SVA (P < 0.05). There was no statistically significant difference in the preoperative TK, GK, SVA, PT, and PI between the lumbar lordosis and lumbar kyphosis groups (P > 0.05). Postoperative complications occurred in three cases. CONCLUSION PSO was a practical method for the treatment of patients with AS combined with thoracolumbar kyphosis. PSO at L3 was recommended to be selected for the lumbar kyphosis to obtain greater SVA correction. CBVA of single-segment PSO may be significantly lower than the two-segment PSO in the management of patients with kyphosis of lower CBVA.
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Affiliation(s)
- Haopeng Luan
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yao Wang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Maierdan Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Qiang Deng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
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Liu Y, Lee MG, Kim JS. Spine Surgery Assisted by Augmented Reality: Where Have We Been? Yonsei Med J 2022; 63:305-316. [PMID: 35352881 PMCID: PMC8965436 DOI: 10.3349/ymj.2022.63.4.305] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/02/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022] Open
Abstract
This present systematic review examines spine surgery literature supporting augmented reality (AR) technology and summarizes its current status in spinal surgery technology. Database search strategies were retrieved from PubMed, Web of Science, Cochrane Library, Embase, from the earliest records to April 1, 2021. Our review briefly examines the history of AR, and enumerates different device application workflows in a variety of spinal surgeries. We also sort out the pros and cons of current mainstream AR devices and the latest updates. A total of 45 articles are included in our review. The most prevalent surgical applications included are the augmented reality surgical navigation system and head-mounted display. The most popular application of AR is pedicle screw instrumentation in spine surgery, and the primary responsible surgical levels are thoracic and lumbar. AR guidance systems show high potential value in practical clinical applications for the spine. The overall number of cases in AR-related studies is still rare compared to traditional surgical-assisted techniques. These lack long-term clinical efficacy and robust surgical-related statistical data. Changing healthcare laws as well as the increasing prevalence of spinal surgery are generating critical data that determines the value of AR technology.
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Affiliation(s)
- Yanting Liu
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Gi Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Koller H, Mühlenkamp K, Hitzl W, Koller J, Ferraris L, Hostettler IC, Hempfing A. Surgical outcomes with anatomic reduction of high-grade spondylolisthesis revisited: an analysis of 101 patients. J Neurosurg Spine 2022; 36:215-225. [PMID: 34534956 DOI: 10.3171/2021.3.spine202091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/25/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The ideal strategy for high-grade L5-S1 isthmic spondylolisthesis (HGS) remains controversial. Critical questions include the impact of reduction on clinical outcomes, rate of pseudarthrosis, and postoperative foot drop. The scope of this study was to delineate predictors of radiographic and clinical outcome factors after surgery for HGS and to identify risk factors of foot drop. METHODS This was a single-center analysis of patients who were admitted for HGS, defined as grade III or greater L5 translation according to the Meyerding (MD) classification. Complete postoperative reduction was defined as MD grade I or less and L5 slip < 20%. Forty-six patients completed health-related quality-of-life questionnaires (Oswestry Disability Index, Physical Component Summary of SF-36, and visual analog scale) and ≥ 2 years' follow-up (average 105 months). A 540° approach was used in 61 patients, a 360° approach was used in 40, and L5 corpectomy was used in 17. Radiographic analysis included measures of global spinopelvic balance (e.g., pelvic incidence [PI], lumbar lordosis) and measurement of lumbosacral kyphosis angle (LSA), L4 slope (L4S), L5 slip (%), and postoperative increase of L5-S1 height. RESULTS The authors included 101 patients with > 1 year of clinical and radiographic follow-up. The mean age was 26 years. Average preoperative MD grade was 3.8 and average L5 slip was 81%; complete reduction was achieved in 55 and 42 patients, respectively, according to these criteria. At follow-up, LSA correlated with all clinical outcomes (r ≥ 0.4, p < 0.05). Forty patients experienced a major complication. Risk was increased in patients with greater preoperative deformity (i.e., LSA) (p = 0.04) and those who underwent L5 corpectomy (p < 0.01) and correlated with greater deformity correction. Thirty-one patients needed revision surgery, including 17 for pseudarthrosis. Patients who needed revision surgery had greater preoperative deformity (i.e., MD grade and L5 slip) (p < 0.01), greater PI (p = 0.02), and greater postoperative L4S (p < 0.01) and were older (p = 0.02), and these patients more often underwent L5 corpectomy (p < 0.01). Complete reduction was associated with lower likelihood of pseudarthrosis (p = 0.08) and resulted in better lumbar lordosis correction (p = 0.03). Thirty patients had foot drop, and these patients had greater MD grade and L5 slip (p < 0.01) and greater preoperative LSA (p < 0.01). These patients with foot drop more often required L5 corpectomy (p < 0.01). Change in preoperative L4S (p = 0.02), LSA (p < 0.01), and L5-S1 height (p = 0.02) were significantly different between patients with foot drop and those without foot drop. A significant risk model was established that included L4S change and PI as independent variables and foot drop as a dependent variable (82% negative predictive value and 71% positive predictive value, p < 0.01). CONCLUSIONS Multivariable analysis identified factors associated with foot drop, major complications, and need for revision surgery, including degree of deformity (MD grade and L5 slip) and correction of LSA. Functional outcome correlated with LSA correction.
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Affiliation(s)
- Heiko Koller
- 1Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- 2Paracelsus Medical University Salzburg, Salzburg, Austria
- 3Research Office (biostatistics), Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Wolfang Hitzl
- 5Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria
- 6Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria; and
| | - Juliane Koller
- 7Department for Orthopedic Surgery, Schoen Clinic Vogtareuth, Vogtareuth, Germany
| | - Luis Ferraris
- 4Spine Center, Werner-Wicker-Clinic, Bad Wildungen, Germany
| | - Isabel C Hostettler
- 1Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Axel Hempfing
- 4Spine Center, Werner-Wicker-Clinic, Bad Wildungen, Germany
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20
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Koller H, Ansorge A, Hostettler IC, Koller J, Hitzl W, Hempfing A, Jeszenszky D. Center of rotation analysis for thoracic and lumbar 3-column osteotomies in patients with sagittal plane spinal deformity: insights in geometrical changes can improve understanding of correction mechanics. J Neurosurg Spine 2021:1-12. [PMID: 34653992 DOI: 10.3171/2021.4.spine21118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Three-column osteotomy (3CO) is used for severe spinal deformities. Associated complications include sagittal translation (ST), which can lead to neurological symptoms. Mismatch between the surgical center of rotation (COR) and the concept of the ideal COR is a potential cause of ST. Matching surgical with conceptual COR is difficult with pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). This mismatch influences correction geometry, which can prevent maximum possible correction. The authors' objective was to examine the sagittal correction geometry and surgical COR of thoracic and lumbar 3CO. METHODS In a retrospective study of patients with PSO or VCR for severe sagittal plane deformity, analysis of surgical COR was performed using pre- and postoperative CT scans in the PSO group and digital radiographs in the VCR group. Radiographic analysis included standard deformity measurements and regional kyphosis angle (RKA). All patients had 2-year follow-up, including neurological outcome. Preoperative CT scans were studied for rigid osteotomy sites versus mobile osteotomy sites. Additional radiographic analysis of surgical COR was based on established techniques superimposing pre- and postoperative images. Position of the COR was defined in a rectangular net layered onto the osteotomy vertebrae (OVs). RESULTS The study included 34 patients undergoing PSO and 35 undergoing VCR, with mean ages of 57 and 29 years and mean RKA corrections of 31° and 49°, respectively. In the PSO group, COR was mainly in the anterior column, and surgical and conceptual COR matched in 22 patients (65%). Smaller RKA correction (27° vs 32°, p = 0.09) was seen in patients with anterior eccentric COR. Patients with rigid osteotomy sites were more likely to have an anterior eccentric COR (41% vs 11%, p = 0.05). In the VCR group, 20 patients (57%) had single-level VCR and 15 (43%) had multilevel VCR. COR was mainly located in the anterior or middle column. Mismatch between surgical and conceptual COR occurred in 24 (69%) patients. Larger RKA correction (63° vs 45°, p = 0.03) was seen in patients with anterior column COR. Patients with any posterior COR had a smaller RKA correction compared to the rest of the patients (42° vs 61°, p = 0.007). CONCLUSIONS Matching the surgical with the conceptual COR is difficult and in this study failed in one- to two-thirds of all patients. In order to avoid ST during correction of severe deformities, temporary rods, tracking rods, or special instruments should be used for correction maneuvers.
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Affiliation(s)
- Heiko Koller
- 1Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Alexandre Ansorge
- 2Department for Spine Surgery, Schulthess Clinic Zurich, Switzerland
| | - Isabel C Hostettler
- 1Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany.,3Department of Neurosurgery, Cantonal Hospital St. Gallen, Switzerland
| | - Juliane Koller
- 4Department for Orthopedic Surgery, Schoen Clinic Vogtareuth, Germany
| | - Wolfgang Hitzl
- 5Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria.,6Research Office (biostatistics), Paracelsus Medical University Salzburg, Austria; and
| | - Axel Hempfing
- 7Spine Center, Werner-Wicker Clinic, Bad Wildungen, Germany
| | - Dezsoe Jeszenszky
- 2Department for Spine Surgery, Schulthess Clinic Zurich, Switzerland
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21
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Kulkarni AG, Praveen GVNR. Quiescent Andersson Lesion Simplifies Deformity Correction: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00121. [PMID: 34559736 DOI: 10.2106/jbjs.cc.21.00303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a case of ankylosing spondylitis with sagittal imbalance and having a suspicious Andersson lesion (AL) on magnetic resonance imaging (MRI) at D12-L1. The segment did not reveal any potential mobility on erect radiographs and supine MRI. L2 pedicle subtraction osteotomy was planned. However, intraoperatively after positioning, the AL widely opened up. This made us reassess the treatment strategy; an interbody fusion was performed, and the correction was achieved using a cantilever mechanism without performing an osteotomy. CONCLUSION A quiescent AL can affect preoperative planning. However, understanding the pathology, reassessing the situation, and reformulating the plans intraoperatively resulted in a successful outcome.
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Affiliation(s)
- Arvind G Kulkarni
- Mumbai Spine Scoliosis and Disc Replacement Centre, Mumbai, India.,Bombay Hospital & Medical Research Centre, Mumbai, India
| | - Goparaju V N R Praveen
- Mumbai Spine Scoliosis and Disc Replacement Centre, Mumbai, India.,Bombay Hospital & Medical Research Centre, Mumbai, India
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22
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Zhao SZ, Qian BP, Huang JC, Qiao M, Wang B, Qiu Y. Variation patterns of cervical alignment in ankylosing spondylitis-related thoracolumbar kyphosis following pedicle subtraction osteotomy in the sitting position: an EOS-based investigation. J Neurosurg Spine 2021; 35:211-218. [PMID: 34049271 DOI: 10.3171/2020.11.spine201420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Both unchanged upper cervical lordosis combined with decreased lower cervical lordosis and decreased upper cervical lordosis combined with decreased lower cervical lordosis have been reported to occur after correction surgery for adult spinal deformity. However, variations in cervical alignment after correction surgery in patients with ankylosing spondylitis (AS) have not been investigated. The current study aimed to investigate the variations in cervical alignment following the correction surgery in AS patients with thoracolumbar kyphosis. METHODS Patients with AS who underwent pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis from June 2016 to June 2019 with a minimum of 1-year follow-up were reviewed. Patients were grouped according to the presence (ossified group) and absence (non-ossified group) of total ossification of the anterior longitudinal ligament (ALL) in the lower cervical spine. Radiographic parameters, including thoracolumbar, craniocervical, and global radiographic parameters, were measured on lateral sitting EOS images. RESULTS Thirty-two patients (27 males and 5 females) with a mean follow-up of 1.5 years were identified. There were 21 patients in the non-ossified group and 11 patients in the ossified group. After PSO, both groups showed a decrease in the occiput-C7 angle (p < 0.001 for both). In the non-ossified group, the C2-7 angle decreased significantly (p < 0.001), while the occiput-C2 angle remained unchanged (p = 0.570). In the ossified group, the occiput-C2 angle decreased significantly (p < 0.001), while C2-7 angle remained unchanged (p = 0.311). In addition, the change in occiput-C2 was correlated with the osteotomy angle in the ossified group (R = 0.776, p = 0.005). CONCLUSIONS The variation patterns of cervical alignment following correction surgery for AS-related thoracolumbar kyphosis were different based on patients with or without total ossification of ALL in the lower cervical spine. When planning PSO for patients in the ossified group, restoration of the physiological upper cervical lordosis angle could be achieved by adjusting the osteotomy angle.
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23
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Akpolat AO, Tasci F, Kilinc BE, Celebi ME, Balioglu MB. A Novel Mathematical Model to Calculate the Osteotomy in Ankylosing Spondylitis. Spine (Phila Pa 1976) 2021; 46:760-764. [PMID: 33399365 DOI: 10.1097/brs.0000000000003928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MINI The authors developed a mathematical model to the sagittal vertical axis (SVA) change in ankylosing spondylitis whom PSO is planned. The mathematical model was developed using trigonometric equations. No significant difference exists between postop SVA change amount and SVA calculated. The mathematical model is reliable in restoring the global sagittal balance.
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Affiliation(s)
- Ahmet Onur Akpolat
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Orthopedics Surgery and Traumatology Department, İstanbul, Turkey
| | - Fatih Tasci
- Yildiz Technical University, Department of Mathematical Engineering, İstanbul, Turkey
| | - Bekir Eray Kilinc
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Orthopedics Surgery and Traumatology Department, İstanbul, Turkey
| | - Mehmet Emin Celebi
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Orthopedics Surgery and Traumatology Department, İstanbul, Turkey
| | - Mehmet Bülent Balioglu
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Orthopedics Surgery and Traumatology Department, İstanbul, Turkey
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24
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Ha AS, Cerpa M, Lenke LG. Staged two level non-contiguous vertebral column resection: technique and case report. JOURNAL OF SPINE SURGERY 2021; 7:100-108. [PMID: 33834132 DOI: 10.21037/jss-20-656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal deformity is a complex issue that can lead to global spine imbalance with subsequent neurologic deficits, clinical deformity, and chronic back pain. The vertebral column resection (VCR) osteotomy technique is used in select cases of rigid severe spinal deformities to achieve significant curve correction. We present a previously undiagnosed ankylosing spondylitis patient with a previously fused spine in marked coronal and sagittal malalignment that required a staged two level non-contiguous VCR for treatment of his fixed thoracic and cervicothoracic kyphoscoliosis. In this patient with ankylosing spondylitis, a postoperative rigid thoracic kyphoscoliosis, and marked truncal imbalance and skull to pelvis imbalance a 2 level non-contiguous VCR performed in a staged fashion at the apex of the thoracic curve and subsequently at the apex of the cervicothoracic curve were utilized to restore sagittal and coronal imbalance and improved skull position and optimal visual gaze. The need for performing two non-contiguous VCR is quite rare and necessary only in a small subset of deformity patients with rigid curves causing malignment in different areas of the spine. The non-contiguous VCR surgery is challenging but also capable of correcting even the most rigid and severe spine deformity with appropriate planning and optimal surgical technique.
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Affiliation(s)
- Alex S Ha
- The Och Spine Hospital, New York-Presbyterian/Columbia University Medical Center New York, NY, USA
| | - Meghan Cerpa
- The Och Spine Hospital, New York-Presbyterian/Columbia University Medical Center New York, NY, USA
| | - Lawrence G Lenke
- The Och Spine Hospital, New York-Presbyterian/Columbia University Medical Center New York, NY, USA
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25
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Zhang PC, Deng Q, Sheng WB, Guo HL, Mamat M, Luo YX, Gao ST. The Sagittal Parameters and Efficacy of Pedicle Subtraction Osteotomy in Patients with Ankylosing Spondylitis and Kyphosis Under Different Lumbar Sagittal Morphologies. Int J Gen Med 2021; 14:361-370. [PMID: 33574694 PMCID: PMC7873030 DOI: 10.2147/ijgm.s292894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022] Open
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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Affiliation(s)
- Peng-Chao Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Qiang Deng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Wei-Bin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Hai-Long Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Mardan Mamat
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Yun-Xiao Luo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
| | - Shu-Tao Gao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, People’s Republic of China
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26
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Wang Y, Li C, Liu L, Qi L. One-level mini-open pedicle subtraction osteotomy for treating spinal kyphosis in patients with ankylosing spondylitis. BMC Musculoskelet Disord 2021; 22:101. [PMID: 33482791 PMCID: PMC7821725 DOI: 10.1186/s12891-021-03974-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report a mini-open pedicle subtraction osteotomy (PSO) technique, to summarize the 2-year follow-up results of 25 patients, and to describe a modified operating table which allows the osteotomy to be closed in a more controllable manner. METHODS We retrospectively reviewed the records of patients with AS who received one-level mini-open PSO between July 2015 and January 2018. The 25 patients with complete medical records and 2-year radiographic follow-up were included in the analysis. Estimated blood loss, operation time, incision length, complications, bed rest period, and length of hospitalization were extracted from the medical records and recorded. RESULTS The mean age of the 25 patients (22 males and 3 females) was 39.5 years. The average global kyphosis(GK) decreased from 70.2° before surgery to 22.3° after surgery; the average C7- sagittal vertical axis (C7-SVA) decreased from 15.5 cm before surgery to 5.1 cm after surgery; the average pelvic incidence(PT) decreased from 37.8° before surgery to 22.5° after surgery. The average length of the incision was 10.2 cm. The average surgical time was 263.0 min, the average estimated blood loss was 840.0 ml, and the average time to mobilization was 4.1 days. CONCLUSIONS The current report shows that one-level PSO can be performed through an incision of about 10 cm. The one-level mini-open PSO could be superior to traditional PSO surgery with respect to cosmetic outcomes. Further comparative studies are necessary to evaluate the current and conventional techniques.
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Affiliation(s)
- Yu Wang
- Department of Orthopaedics, Peking University First Hospital, 100034, Beijing, China
| | - Chunde Li
- Department of Orthopaedics, Peking University First Hospital, 100034, Beijing, China
| | - Long Liu
- Department of Orthopaedics, Peking University First Hospital, 100034, Beijing, China
| | - Longtao Qi
- Department of Orthopaedics, Peking University First Hospital, 100034, Beijing, China.
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27
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Alahmari ASA, Qari SK, Asiri RI, Almohammadi TA, Alalawi MA, Aljahdali HM, Alnasser AH, Alaqeel FA, Kazim OA, Qasem HAO. An Overview on the Role of Surgical Management in Ankylosing Spondylitis. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/9azbvu4zlt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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28
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Bodon G, Kiraly K, Ruttkay T, Hirt B, Koller H. Feasibility of the Far Lateral Suboccipital Approach to the Retroodontoid Region. How Much Bone Removal Is Truly Needed? Neurospine 2020; 17:921-928. [PMID: 33401871 PMCID: PMC7788401 DOI: 10.14245/ns.2040304.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
Objective The posterolateral extradural suboccipital approach can be used to reach the anterior epidural space and the retro-odontoid regions. The extent of necessary bone removal of the atlas vertebra (C1) has not yet been defined. We studied the changes in the size of the horizontal and vertical surgical windows using stepwise bone removal of C1. A representative case is shown.
Methods The anatomical study was performed bilaterally on five Thiel-fixed human cadavers (mean age, 83.7 years). The surgical window (horizontal × vertical) required to access the retro-odontoid region via a posterolateral approach was measured for an intact C1 posterior arch, after a semicircular inferior partial resection of the C1 arch, after resection of the unilateral hemiarch of C1, and finally after drilling approximately 3 mm from the medial aspect of the lateral mass of C1.
Results The intact C1 resulted in a very narrow surgical window of 6.3 mm × 9.7 mm (horizontal × vertical). The vertical window increased to a 13 mm after the semicircular inferior partial resection of the C1 arch and to 17.3 mm in the case of removal of the ipsilateral C1 posterior arch. The bone removal from the medial aspect of the C1 lateral mass resulted in a widening of the horizontal surgical window to 10.3 mm. The final size of the surgical window was 10.3 mm × 17.3 mm. The patient with severe kyphoscoliosis of the craniocervical spine was successfully operated on using odontoid and C1–2 facet osteotomies.
Conclusion If only the anterior epidural space or the base of the odontoid needs to be reached, the semicircular inferior partial resection of the C1 arch allows for an adequate surgical window. The tip of the odontoid could only be reached if the ipsilateral posterior arch is resected.
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Affiliation(s)
- Gergely Bodon
- Department of Orthopaedic Surgery, Klinikum Esslingen, Esslingen am Neckar, Germany.,Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embriology, Semmelweis University, Budapest, Hungary.,Clinical Anatomy Tübingen, University of Tübingen, Germany
| | - Kristof Kiraly
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embriology, Semmelweis University, Budapest, Hungary
| | - Tamas Ruttkay
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embriology, Semmelweis University, Budapest, Hungary
| | - Bernhard Hirt
- Clinical Anatomy Tübingen, University of Tübingen, Germany
| | - Heiko Koller
- Department of Neurosurgery, Klinikum Rechts der Isar, München, Germany
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29
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Heyde CE, Glasmacher S, von der Höh NH, Völker A. Spontaneous intraoperative lumbar fracture leading to an unexpected correction in ankylosing spondylitis corrective surgery - a case report. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2020; 9:Doc04. [PMID: 33299739 PMCID: PMC7710696 DOI: 10.3205/iprs000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Severe kyphotic deformity in patients with ankylosing spondylitis can be corrected surgically to achieve a better spinal alignment and an improved visual axis. Different surgical techniques are used today depending on the extent of ossification and the degree of kyphosis. It is well known that the underlying disease leads to distinct biomechanical changes of the spinal column causing an increased fracture risk especially in case of minor trauma. This includes manipulations during surgical procedures as well as during the required perioperative measures. We present the case of a 45-year-old patient with severe global kyphotic deformity due to ankylosing spondylitis. During the elective corrective surgery (pedicle subtraction osteotomy at the level of L3) the patient sustained a spontaneous fracture at L2/3. This fortunately nondisplaced wedge-shaped fracture in the sense of a Smith-Peterson osteotomy led to a spontaneous correction of the kyphosis. The described unexpected event required a change in the surgical strategy. Correction could be achieved using a two-stage surgical procedure without further drawbacks for the patient. This case report stresses the need of particular attention regarding the increased susceptibility of the spinal column in case of ankylosing spondylitis.
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Affiliation(s)
- Christoph-Eckhard Heyde
- Spine Division, Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Germany
| | - Stefan Glasmacher
- Spine Division, Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Germany
| | - Nicolas H von der Höh
- Spine Division, Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Germany
| | - Anna Völker
- Spine Division, Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Germany
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30
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van Royen BJ. Preoperative Planning and the Use of Free Available Software for Sagittal Plane Corrective Osteotomies of the Lumbar Spine in Ankylosing Spondylitis. Orthop Res Rev 2020; 12:171-182. [PMID: 33235523 PMCID: PMC7680187 DOI: 10.2147/orr.s275860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
Background Ankylosing spondylitis (AS) may cause a severe rigid thoracolumbar kyphotic deformity (TLKD) that leads to considerable disturbances of posture and spinal balance. In few patients, a corrective osteotomy of the lumbar spine may be considered. Preoperative planning of a lumbar osteotomy for correction of a severe TLKD due to AS is important to correct patient's sagittal balance and view angle. There is a need for accurate preoperative planning that can be used easily in daily practice. Methods The basic biomechanical and mathematical principles of preoperative planning for correction of a TLKD due to AS are described. A search was performed for free available computer programs that can be used for pre-operative planning of spinal osteotomies in AS. Finally, the use of these computer programs is illustrated and described. Results Sagittal balance is measured on a standing lateral full-length radiograph of the spine. The assessment of the pelvic parameters (PI, PT, SS) in conjunction with sagittal vertical axis (SVA) and chin-brow-to-vertical angle (CBVA) provides a comprehensive picture of the sagittal spinal alignment and compensatory mechanisms of the patient. The relation between the level of lumbar osteotomy and the amount of correction needed can be calculated with different elementary trigonometric equations. Two free available computer programs, ASKyphoplan and Surgimap, are illustrated and described that can be used for pre-operative planning of spinal osteotomies in AS. Conclusion Preoperative planning of the lumbar osteotomy in AS involves assessment of the combined effect of location of the osteotomy, amount of bone resection, SVA, CBVA, and pelvic parameters. Two free available computer programs, ASKyphoplan and Surgimap, are easy to use in clinical practice to predict postoperative sagittal balance of lumbar osteotomies in patients with severe TLKD due to AS.
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Affiliation(s)
- Barend J van Royen
- Department of Orthopaedic Surgery, Amsterdam UMC, Vrije Universiteit and University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Koller H, Koller J, Stengel F, Meyer B. [Surgical challenges with spinal balance in adult spinal deformities-the forgotten coronal plane]. DER ORTHOPADE 2020; 49:883-892. [PMID: 32880703 DOI: 10.1007/s00132-020-03993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article gives a brief overview of the importance, planning and correction of coronal spinal imbalance in patients with adult and pediatric spinal deformity.
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Affiliation(s)
- Heiko Koller
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland. .,Universitätsklinik für Orthopädie und Traumatologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
| | | | - Felix Stengel
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Bernhard Meyer
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Wang ZW, Shu JW, Li Md FC, Chen WS, Chen QX, Chen G, Li J. Cervical Flexion Osteotomy through One-Stage Posterior-Anterior-Posterior Approach for Cervical Extension Deformity in Ankylosing Spondylitis: A Novel Surgical Technique. Orthop Surg 2020; 12:1005-1009. [PMID: 32488998 PMCID: PMC7307245 DOI: 10.1111/os.12670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/29/2020] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
The present study was to introduce a new surgical technique of cervical flexionosteotomy, with an emphasis on the clinical and radiographic outcomes. Two male patients aged 45 and 21 years presented with cervical extension deformity in ankylosing spondylitis (AS). Both patients exhibited upward deviation of the forward gaze. The chin brow vertical angle (CBVA) were 15° upward and 5° downward, respectively; and the sagittal vertical axis (SVA) were‐13.2mm and 195.7mm, respectively. Aposterior transverse release was performed at C7‐T1, exposing the theca and C8 nerve roots to facilitate closure of theosteotomy site. Then, an anterior closing‐wedgeosteotomy of C7‐T1 was performed followed with anterior internal fixation with a locking plate to prevent any translation. After closure and anterior fixation, patients were returned to the proneposition, and posterior screw‐rod instrumentation was used for further stabilization. The follow‐up periods were 20 and 10 months, respectively. At the last follow‐up, CBVA and SVA of Patient 1 were 14° downwardand ‐12.6mm; and CBVA and SVA of Patient 2 were 1° downward and 75.6mm respectively, indicating the visual angle and sagittal balance were significantly improved. No intraoperative or postoperative complications were encountered. Full‐spine radiographs of each patient at the last visit confirmed successfulbony union. The present study was the first report introducing a novel flexion osteotomy for cervical extension deformity in AS through a posterior‐anterior‐posterior approach inone‐stage. The improved forward gaze and no complications demonstrated the effectiveness and safety of the novel technique, suggesting that it might provide a more feasible method for the correction of cervical extension deformity.
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Affiliation(s)
- Zhi-Wei Wang
- Orthopedics Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jia-Wei Shu
- Orthopedics Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang-Cai Li Md
- Orthopedics Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei-Shan Chen
- Orthopedics Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi-Xin Chen
- Orthopedics Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gang Chen
- Orthopedics Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Li
- Orthopedics Department, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Huang JC, Qian BP, Qiu Y, Wang B, Yu Y, Qiao M. What is the optimal postoperative sagittal alignment in ankylosing spondylitis patients with thoracolumbar kyphosis following one-level pedicle subtraction osteotomy? Spine J 2020; 20:765-775. [PMID: 31734451 DOI: 10.1016/j.spinee.2019.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiographic realignment objectives for the surgical correction of adult spinal deformity (ASD) have been well-described. However, the optimal sagittal spinopelvic alignment after corrective osteotomy for thoracolumbar kyphosis secondary to ankylosing spondylitis (AS) is still unknown so far. PURPOSE To comprehensively investigate the relationship between radiographic parameters and clinical outcomes measured by Oswestry Disability Index (ODI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in thoracolumbar kyphosis patients caused by AS following one-level pedicle subtraction osteotomy (PSO) and to determine the optimal sagittal alignment at a minimum of 2-year follow-up. STUDY DESIGN A retrospective review of consecutive AS patients from one institution (2006-2016). PATIENT SAMPLE One hundred AS-related thoracolumbar kyphosis patients who underwent one-level PSO with a minimum of 2-year follow-up (range, 2-10 years). OUTCOME MEASURES Spinopelvic parameters at final follow-up (≥2 years) included thoracic kyphosis, lumbar lordosis, osteotomized vertebra angle, pelvic tilt (PT), sacral slope (SS), pelvic incidence, sagittal vertical axis, spinosacral angle (SSA), T1 pelvic angle (TPA), spinopelvic angle (SPA), and global kyphosis. Clinical outcomes at final follow-up (≥2 years) was evaluated by ODI and BASDAI, and ODI<20 was defined as good clinical outcome. METHODS Pre- and postoperative radiographic and clinical outcomes were compared by paired samples t test. The correlation between the postoperative radiographic parameters and clinical outcomes was investigated by Pearson correlation analysis. Linear regression analysis was performed to construct predictive models of the clinically relevant radiographic parameters based on ODI scores and to determine the realignment goals. Multiple stepwise regression analysis was applied to figure out the major radiographic contributors of ODI score at the final follow-up. RESULTS In total, 100 AS patients (92 males and 8 females) with a mean age of 34.7±9.5 years (range, 17-63 years) were followed up for 38.6±17.5 months (range, 24-120 months). At the final follow-up, PT and TPA were positively correlated with both ODI and BASDAI score (p<.05). Although SS, SSA, and SPA were negatively associated with the score of ODI (p<.05), and BASDAI was negatively related to SPA (p<.05). Predicting regression models of the clinically-relevant radiographic parameters were built based on the ODI score at the last follow-up. CONCLUSIONS Based on the regression models, the optimal sagittal alignment of AS patients satisfying good clinical outcome (ODI<20) at a minimum of 2-year follow-up was: PT<24°, SSA>108°, TPA<22°, and SPA>152°. Realizing the aforementioned realignment goals may contribute to satisfied clinical outcome for AS patients with thoracolumbar kyphosis undergoing one-level PSO.
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Affiliation(s)
- Ji-Chen Huang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
| | - Yong Qiu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bin Wang
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yang Yu
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mu Qiao
- Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Liu GP, Qian BP, Qiu Y, Huang JC, Qiao M, Wang B. Is Any Correlation Present Between the Severity of Syndesmophytes and Spinopelvic and Clinical Parameters in Advanced Ankylosing Spondylitis? World Neurosurg 2020; 137:e618-e625. [PMID: 32105868 DOI: 10.1016/j.wneu.2020.02.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study evaluated the severity of syndesmophytes and its correlation with the spinopelvic and clinical outcomes in patients with ankylosing spondylitis (AS). METHODS The data from 41 consecutive patients with AS who had undergone pedicle subtraction osteotomy surgery at our institution were reviewed. The computed tomography syndesmophyte score (CTSS), a novel method of evaluating the severity of syndesmophytes, was applied to assess the syndesmophytes of the whole, cervical, thoracic, and lumbar spine. The measured spinopelvic parameters included global kyphosis, sagittal vertical axis, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope. The Oswestry disability index questionnaire, C-reactive protein, and erythrocyte sedimentation rate were used to evaluate the clinical outcome. The Pearson correlation test was performed to identify correlations between syndesmophyte severity and the spinopelvic and clinical parameters. RESULTS The Pearson correlation analysis demonstrated that the whole CTSS (WCTSS), cervical CTSS, thoracic CTSS, and lumbar CTSS (LCTSS) correlated significantly with each other (P < 0.05). All the CTSSs correlated positively with age, disease duration, and pelvic tilt (P < 0.05). In addition, both sagittal vertical axis and lumbar lordosis were significantly related to the WCTSS, cervical CTSS, and LCTSS (P < 0.05). The Oswestry disability index correlated negatively with the WCTSS (r = -0.312; P < 0.05), thoracic CTSS (r = -0.314; P < 0.05), and LCTSS (r = -0.343; P < 0.05). CONCLUSIONS In advanced AS, old age and a long disease duration are risk factors for the progression of syndesmophytes. The progression of syndesmophytes might contribute to spinal sagittal malalignment. With serious syndesmophytes, pelvic retroversion seems to be the major compensatory mechanism for spinal sagittal malalignment.
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Affiliation(s)
- Guang-Pu Liu
- Department of Spinal Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China; Department of Spinal Surgery, Xuzhou Central Hospital, Xuzhou, China
| | - Bang-Ping Qian
- Department of Spinal Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Yong Qiu
- Department of Spinal Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Ji-Chen Huang
- Department of Spinal Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Mu Qiao
- Department of Spinal Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Bin Wang
- Department of Spinal Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
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Combined percutaneous and open instrumentation for thoracolumbar kyphosis correction by two-level pedicle subtraction osteotomy in ankylosing spondylitis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:939-947. [PMID: 31980911 DOI: 10.1007/s00590-020-02631-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND A long global thoracolumbar kyphosis is common in ankylosing spondylitis. Surgical correction of fixed sagittal malalignment by pedicle subtraction osteotomy (PSO) might improve disability and quality of life (QoL). Two-level osteotomies represent major procedures with a risk of hemorrhage. Combined open and minimal invasive surgery has not been described and might be considered. CASE PRESENTATION A 30-year-old female with ankylosing spondylitis was treated by golimumab and teriparatide. The treatment was stopped during pregnancy which led to vertebral compression fractures and kyphosis of 50° between T11 and L3. A PSO was planned at the kyphotic apex L2. The second PSO was planned at L4 according to the pelvic incidence of 56°, matching with a spinopelvic alignment Roussouly type 3. A derived full balance integrated method was used to calculate the amount of correction. During the first stage surgery, an open approach was performed from L1 to pelvis and combined with percutaneous cement-augmented instrumentation in already fused segments T5-T12, thus reducing perioperative morbidity. A stepwise approach including L2 PSO closure with temporary rods and L4 PSO with final instrumentation was used. Blood loss was estimated around 1100 ml. The patient was able to walk on the second day after surgery. A secondary anterior fusion with LLI cages from L2 to L5 and an ALIF at L5-S1 were performed because of high non-ossified intervertebral disks to reduce the risk for nonunion and rod fractures. At 2-year follow-up, the patient's QoL had significantly improved and full spine radiographs showed stable normalized sagittal parameters. CONCLUSION The combined open and percutaneous approach was feasible and might be considered as an alternative option to conventional open surgery when planning major deformity correction in ankylosing spondylitis.
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Koller H. Expert's comment concerning Grand Rounds case entitled "Management of a pseudarthrosis with sagittal malalignment in a patient with ochronotic spondyloarthropathy" by Alkasem W, Boissiere L, Obeid I, Bourghli A (Eur Spine J; 2019: doi.org/10.1007/s00586-019-06020-2). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2290-2292. [PMID: 31286246 DOI: 10.1007/s00586-019-06050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 06/09/2023]
Affiliation(s)
- H Koller
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
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Feng C, Tao H, Yang K, Xu J, Duan C, Yang W, Li H, Li H. Modified Closing-Opening Wedge Osteotomy to Correct Kyphosis in Ankylosing Spondylitis. Med Sci Monit 2019; 25:6532-6538. [PMID: 31471964 PMCID: PMC6738018 DOI: 10.12659/msm.915836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to analyze the clinical and radiological outcomes of modified closing-opening wedge osteotomy (mCOWO) for correcting kyphosis in ankylosing spondylitis (AS) patients. Material/Methods From April 2012 to April 2017, records of consecutive patients who underwent mCOWO were reviewed. The clinical and radiological outcomes were analyzed preoperatively, postoperatively, and at the most recent follow-up. Results Eleven AS patients underwent mCOWO, with a mean follow-up of 19.4 months (range, 12–45 months). The average sagittal vertical axis (SVA) was corrected from 191.9 mm preoperatively to 75.9 mm postoperatively (P<0.05) and 78.9 mm at the most recent follow-up (P<0.05). The average correction angles at the osteotomy site were 44.5° postoperatively and 45.0° at the most recent follow-up (P>0.05). Sagittal translation (ST) occurred in 2 patients, and 5 mm was the maximum. There was no neurologic damage. Solid fusion was observed at the most recent follow-up in all patients. Conclusions Modified closing-opening wedge osteotomy (mCOWO) is an effective technique for correcting kyphosis in patients with AS.
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Affiliation(s)
- Chaoshuai Feng
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Huiren Tao
- Department of Orthopaedics, Shenzhen University General Hospital, Shenzhen, Guangdong, China (mainland)
| | - Kai Yang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Jiawei Xu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Chunguang Duan
- Department of Orthopaedics, Shenzhen University General Hospital, Shenzhen, Guangdong, China (mainland)
| | - Weizhou Yang
- Department of Orthopaedics, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Huan Li
- Department of Cardiology, Xijing Hospital, Xi'an, Shaanxi, China (mainland)
| | - Haopeng Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X, Qiu G, Cao X, Weng X. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res 2019; 7:22. [PMID: 31666997 PMCID: PMC6804882 DOI: 10.1038/s41413-019-0057-8] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
Ankylosing spondylitis (AS), a common type of spondyloarthropathy, is a chronic inflammatory autoimmune disease that mainly affects spine joints, causing severe, chronic pain; additionally, in more advanced cases, it can cause spine fusion. Significant progress in its pathophysiology and treatment has been achieved in the last decade. Immune cells and innate cytokines have been suggested to be crucial in the pathogenesis of AS, especially human leukocyte antigen (HLA)‑B27 and the interleukin‑23/17 axis. However, the pathogenesis of AS remains unclear. The current study reviewed the etiology and pathogenesis of AS, including genome-wide association studies and cytokine pathways. This study also summarized the current pharmaceutical and surgical treatment with a discussion of future potential therapies.
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Affiliation(s)
- Wei Zhu
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Xuxia He
- 2Department of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Kaiyuan Cheng
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Linjie Zhang
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Di Chen
- 3Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612 USA
| | - Xiao Wang
- 4Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Guixing Qiu
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Xu Cao
- 4Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Xisheng Weng
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
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A bibliometric analysis of the global research in ankylosing spondyloarthritis (2008-2017). Rheumatol Int 2019; 39:1091-1097. [PMID: 31025140 DOI: 10.1007/s00296-019-04308-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/15/2019] [Indexed: 10/27/2022]
Abstract
The current study was to investigate the quantity and quality of researches in the field of ankylosing spondylitis, and to reveal the characteristics of worldwide productivity on this disease. This was a bibliometric study on ankylosing spondylitis using Web of Science. The numbers of papers, citations, research output normalized by population and gross domestic product, and the main active countries were analyzed. A total number of 7239 papers were published between 2008 and 2017. The yearly number of papers published during this period showed a significant increase (p < 0.001). North America, West Europe and East Asia were the main regions for AS papers. High-income countries contributed the greatest proportion of papers (70.49%). The research productivity from middle- and low-income countries was low (29.45%; 0.06%). The United States was the country with the greatest contributions between 2008 and 2017 (12.47%), followed by China (12.17%), Turkey (8.34%), Germany (7.82%), and the United Kingdom (5.97%). Significantly positive correlations were proved between the number of papers and population/gross domestic product (p < 0.05). From 2013, the number of AS publications by the authors from China exceeded those from the United States. However, China had far less total citations (7219 vs. 22,043) and average citations (8.19 vs. 24.41) than the United States. Denmark had the greatest productivity when normalized by population, followed by Norway, and Netherlands. When normalized by gross domestic product, Denmark led the top list, followed by Netherlands, and Greece. Papers from Australia showed the highest average citation (32.64), followed by Netherlands (31.63), and Germany (26.88). The current study showed a noticeable growth in global research output on ankylosing spondylitis between 2008 and 2017. High-income countries especially the United States had the greatest contributions. The contributions from middle- and low-income countries were considerably small. The number of papers published by countries was positively associated with their population and gross domestic product. Although China had exceeded the United States in the quantity of yearly AS publications, the quality of papers from China was lower compared to the United States. European countries may have better performance relative to their population and economic size.
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Guo Z, Cui W, Sang DC, Sang HP, Liu BG. Clinical Relevance of Cervical Kinematic Quality Parameters in Planar Movement. Orthop Surg 2019; 11:167-175. [PMID: 30884156 PMCID: PMC6594496 DOI: 10.1111/os.12435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 12/14/2022] Open
Abstract
Comprehending cervical spinal motion underlies the understanding of the mechanisms of cervical disorders. We aimed to better define the clinical relevance of cervical spine kinematics, focusing on quality parameters describing cervical spine planar motion. The most common study focuses were kinematic quality parameters after cervical arthroplasty and in normal subjects, patients with cervical degeneration, and patients with cervical deformities. Kinematic quality parameters are important for cervical degeneration prevention, being detected sooner than differences on imaging examinations and being significantly related to the degree of cervical degeneration. Kinematic quality parameters are effective for evaluating the changes of cervical motion pattern after cervical fusion and non‐fusion, assessing operative and adjacent segments in the early stages, and predicting adjacent segment degeneration. However, owing to current research limitations, and controversy about the changes of kinematic quality parameters after different surgical procedures, current assessments are limited to cervical spine flexion and extension. Different osteotomy methods of cervical deformity have different effects on cervical motion patterns and quality parameters. Choosing the most effective surgical method remains a challenge and kinematic quality parameters in cervical deformity are important future research topics. This review highlights the instantaneous center of rotation, the center of rotation, and the instantaneous axis of rotation as being important kinematic quality parameters of cervical spinal motion. These can be used to detect abnormal cervical mobility, to diagnose cervical degeneration, to design disc protheses, and to evaluate surgical effects earlier than other methods. Owing to limitations of research methods there is variation in the way parameters are defined by various researchers. No uniform standard exists for defining degenerative motion quality parameters in normal asymptomatic, degenerative, and postoperative patients. Therefore, further study is required. New study techniques and defining kinematic quality parameters in normal subjects will clarify the definitions of these parameters, enhancing their future clinical usefulness.
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Affiliation(s)
- Ze Guo
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wei Cui
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Da-Cheng Sang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hong-Peng Sang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bao-Ge Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
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The Michel Benoist and Robert Mulholland yearly European Spine Journal review: a survey of the "surgical and research" articles in the European Spine Journal, 2018. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1-9. [PMID: 30604293 DOI: 10.1007/s00586-018-5856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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Koller H, Ames C, Mehdian H, Bartels R, Ferch R, Deriven V, Toyone H, Shaffrey C, Smith J, Hitzl W, Schröder J, Robinson Y. Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:324-344. [PMID: 30483961 DOI: 10.1007/s00586-018-5835-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/25/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND PURPOSE Little information exists on surgical characteristics, complications and outcomes with corrective surgery for rigid cervical kyphosis (CK). To collate the experience of international experts, the CSRS-Europe initiated an international multi-centre retrospective study. METHODS Included were patients at all ages with rigid CK. Surgical and patient specific characteristics, complications and outcomes were studied. Radiographic assessment included global and regional sagittal parameters. Cervical sagittal balance was stratified according to the CSRS-Europe classification of sagittal cervical balance (types A-D). RESULTS Eighty-eight patients with average age of 58 years were included. CK etiology was ankylosing spondlitis (n = 34), iatrogenic (n = 25), degenerative (n = 9), syndromatic (n = 6), neuromuscular (n = 4), traumatic (n = 5), and RA (n = 5). Blood loss averaged 957 ml and the osteotomy grade 4.CK-correction and blood loss increased with osteotomy grade (r = 0.4/0.6, p < .01). Patients with different preop sagittal balance types had different approaches, preop deformity parameters and postop alignment changes (e.g. C7-slope, C2-7 SVA, translation). Correction of the regional kyphosis angle (RKA) was average 34° (p < .01). CK-correction was increased in patients with osteoporosis and osteoporotic vertebrae (POV, p = .006). 22% of patients experienced a major long-term complication and 14% needed revision surgery. Patients with complications had larger preop RKA (p = .01), RKA-change (p = .005), and postop increase in distal junctional kyphosis angle (p = .02). The POV-Group more often experienced postop complications (p < .0001) and revision surgery (p = .02). Patients with revision surgery had a larger RKA-change (p = .003) and postop translation (p = .04). 21% of patients had a postop segmental motor deficit and the risk was elevated in the POV-Group (p = .001). CONCLUSIONS Preop patient specific, radiographic and surgical variables had a significant bearing on alignment changes, outcomes and complication occurrence in the treatment of rigid CK.
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Affiliation(s)
- H Koller
- Spine and Scoliosis Center, Schön Klinik Vogtareuth, Krankenhausstrasse 20, 83569, Vogtareuth, Germany. .,Department for Trauma and Sports Injuries, Paracelsus Medical University, Salzburg, Austria.
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[Fixed cervical high-grade kyphosis : Chin-on-chest deformity-Treatment plan]. DER ORTHOPADE 2018; 47:505-517. [PMID: 29666897 DOI: 10.1007/s00132-018-3564-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Surgical correction of severe and rigid cervical kyphosis with chin-on-chest deformity poses significant challenges to both the patient and surgeon once surgery is considered as the treatment of choice. OBJECTIVES This article presents the current concepts of corrective surgery for patients with severe and rigid cervical kyphosis. MATERIAL AND METHODS Narrative review and report of clinical experience. RESULTS The treatment of severe cervical kyphosis indicates a dedicated deformity assessment, the analysis of regional and global imbalance, the identification of spinal sagittal plane compensation mechanisms, detailed radiographic and clinical planning of corrective surgery, and the meticulous performance of surgical correction. Most recent large-scale studies serve as evidence for the benefit of surgical correction and outline the complications that need to be targeted during and after surgery. CONCLUSION Surgical correction of severe cervical kyphosis can be a pleasant and life-changing event for the disabled patient.
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