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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 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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Zheng GB, Hong Z, Wang Z, Zheng B. A novel technique of transpedicular opening-wedge osteotomy for treatment of rigid kyphosis in patients with ankylosing spondylitis. BMC Surg 2022; 22:155. [PMID: 35501784 PMCID: PMC9063357 DOI: 10.1186/s12893-022-01610-2] [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: 09/11/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the effectiveness and feasibility of a novel vertebral osteotomy technique, transpedicular opening-wedge osteotomy (TOWO) was used to correct rigid thoracolumbar kyphotic deformities in patients with ankylosing spondylitis (AS). METHODS Eighteen AS patients underwent TOWO to correct rigid thoracolumbar kyphosis. Radiographic parameters were compared before surgery, 1 week after surgery and at the last follow-up. The SRS-22 questionnaire was given before surgery and at the last follow-up to evaluate clinical improvement. The operating time, estimated blood loss and complications were analyzed. RESULTS The mean operating time and estimated blood loss were 236 min and 595 ml, respectively. The mean preoperative sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic tilt (PT) and thoracolumbar kyphosis (TLK) were 158.97 mm, 51.24 mm, 43.63 mm and 41.74 mm, respectively, and decreased to 66.72 mm, 35.96 mm, 27.21 mm and 8.67 mm at the last follow-up. The mean preoperative lumbar lordosis (LL) and sacral slope (SS) were 8.30 ± 24.43 mm and 19.67 ± 9.40 mm, respectively, which increased to 38.23 mm and 28.13 mm at the last follow-up. The mean height of the anterior column of osteotomized vertebrae increased significantly from 25.17 mm preoperatively to 37.59 mm at the last follow, but the height of the middle column did not change significantly. SRS-22 scores were improved significantly at the last follow-up compared with preoperatively. Solid bone union was achieved in all patients after 12 months of follow-up, and no screw loosening, screw removal or rod breakage was noticed at the last follow-up. CONCLUSIONS TOWO could achieve satisfactory kyphosis correction by opening the anterior column instead of vertebral body decancellation and posterior column closing, thus simplifying the osteotomy procedure and improving surgical efficacy.
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Affiliation(s)
- Guang Bin Zheng
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Ximen Road 150, Linhai, 317000, Zhejiang, China
| | - Zhenghua Hong
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Ximen Road 150, Linhai, 317000, Zhejiang, China.
| | - Zhangfu Wang
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Ximen Road 150, Linhai, 317000, Zhejiang, China
| | - Binbin Zheng
- Department of Spine Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Ximen Road 150, Linhai, 317000, Zhejiang, China
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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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Systemic changes associated with quality of life after surgical treatment of kyphotic deformity in patients with ankylosing spondylitis: a systematic review. 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 2020; 29:794-802. [PMID: 32020389 DOI: 10.1007/s00586-020-06322-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/17/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE In addition to changes in the skeletal system after spinal osteotomy for treatment of kyphotic deformity in advanced-stage AS patients, many other systemic changes associated with the patients' quality of life were reported. The purpose of this study was to conduct a systemic review of the literature to determine systemic changes associated with patients' quality of life following correction of kyphotic deformity secondary to ankylosing spondylitis. METHODS We searched the databases PubMed, EMBASE, Clinicalkey and Cochrane Library without time restriction. Selected papers were assessed by published guidelines. We investigated systemic changes associated with patients' quality of life after surgical treatment of advanced ankylosing spondylitis. RESULTS The initial search yielded 888 citations. Twelve of these studies met the inclusion and exclusion criteria. Two were level II evidence study, and ten were level III evidence studies. Changes were reported including aorta length, abdominal morphology, digestive function, cardiopulmonary function, psychological status, and sexual activity. CONCLUSIONS In addition to skeletal changes after spinal osteotomy for treatment of kyphotic deformity in advanced-stage AS patients, many other changes were reported. Spine surgeons should pay more attention to these life quality-related changes and be aware of potential risks when performing surgery for advanced-stage AS patients. These slides can be retrieved under Electronic Supplementary Material.
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Sabou S, Mehdian H, Pasku D, Boriani L, Quraishi NA. Health-related quality of life in patients undergoing cervico-thoracic osteotomies for fixed cervico-thoracic kyphosis in patients 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 2018; 27:1586-1592. [DOI: 10.1007/s00586-018-5530-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 02/04/2018] [Accepted: 02/17/2018] [Indexed: 10/18/2022]
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