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Ye Z, Shan B, Wei X, Zhao X, Shan H, Zhou Z, Dai J, Du S, Zhou X. Clinical Observation of Posterior Approach for Surgical Treatment of Thoracolumbar Pseudarthrosis in Ankylosing Spinal Disorders. World Neurosurg 2024; 183:e963-e970. [PMID: 38266990 DOI: 10.1016/j.wneu.2024.01.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the surgical effectiveness of posterior procedure with long segment stabilization for treating thoracolumbar pseudarthrosis associated with ankylosing spinal disorders (ASDs) without anterior fusion or osteotomy. METHODS Twelve patients with thoracolumbar pseudarthrosis in ASD were enrolled. All patients underwent posterior long-segment stabilization procedures. In some patients, the percutaneous technique or the aid of a robot or O-arm navigation was utilized for pedicle screw implantation. The clinical results were evaluated by means of the visual analog scale and Oswestry Disability Index. Radiological outcomes were evaluated for bone fusion, anterior column defect, local kyphotic correction, and position of the pedicle screws. RESULTS All patients experienced effective bone fusion at the sites of pseudarthrosis. The mean operative time was 161.7 ± 57.1 minutes, and the average amount of blood loss was 305.8 ± 293.2 mL. For 6 patients who underwent surgery with the assistance of a robot or O-arm navigation, there was no statistically significant difference observed in terms of operative time and mean blood loss compared to those who used the freehand technique (P > 0.05). The visual analog scale score, Oswestry Disability Index value, and mean local kyphotic angle showed significant improvements at the final follow-up (P < 0.05). The accuracy of pedicle screw placement was 96%. CONCLUSIONS Posterior surgery with long-segment fixation, without anterior fusion or osteotomy, can achieve satisfactory outcomes in ASD patients with thoracolumbar pseudarthrosis. The application of percutaneous techniques, as well as the assistance of robots or navigation technique may be a good choice for the treatment of pseudarthrosis in ASD patients.
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Affiliation(s)
- Zhiyuan Ye
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Orthopedics, Sihong Hospital, Sihong, Jiangsu Provience, China
| | - Bingchen Shan
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiufang Wei
- Department of Orthopedics, Sihong Hospital, Sihong, Jiangsu Provience, China
| | - Xushen Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Huajian Shan
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhentao Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Dai
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shengyang Du
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Orthopedics, First People's Hospital of Xuzhou, Xuzhou, China
| | - Xiaozhong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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Huang Z, Guo J, Zhang J, We L, Wang J, Jia Y. Clinical outcomes for andersson lesion in patients with ankylosing spondylitis by transforaminal thoracolumbar intervertebral fusion surgery. J Back Musculoskelet Rehabil 2023; 36:237-244. [PMID: 35988216 DOI: 10.3233/bmr-220053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Andersson lesion (AL) is a rare complication of ankylosing spondylitis (AS). Its clinical outcome of surgical treatment needs further exploration. OBJECTIVE To evaluate the clinical and radiological outcomes of transforaminal thoracolumbar intervertebral fusion (TTIF) in the treatment of AS patients with thoracolumbar AL. METHODS Fourteen patients with thoracolumbar AL who suffered from back pain, spinal instability or kyphotic deformity were retrospectively recruited. The clinical outcomes were evaluated with Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiological outcomes were measured with local kyphotic (LK) angle and general kyphotic (GK) angle. RESULTS Before surgical treatment for the AL patients, their VAS score and ODI score was 8.0 ± 0.2 and 64.0 ± 6.9, respectively. After TTIF surgery, VAS score of the patients was improved to 2.4 ± 0.5 (p< 0.01) and ODI score was decreased to 17.0 ± 3.7 (p< 0.01). One patient with neurological deficit showed an improvement in the Frankel grade from C to D and all others were grated E-level before and after surgery. For radiological outcomes, patients' LK angle was reduced from 18.5 ± 7.2 to 11.0 ± 6.4 (p< 0.01) and GK angle was reduced to 38.6 ± 8.8 from 42.8 ± 10.4 (p< 0.01) at the 1-year follow-up. CONCLUSION For AS patients with thoracolumbar AL, we propose that TTIF is an effective and safe operative treatment, which can achieve good fusion, satisfactory radiological and clinical outcomes.
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Affiliation(s)
- Zheng Huang
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China.,Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.,Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ji Guo
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China.,Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.,Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianpo Zhang
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China.,Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Licheng We
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China.,Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Jiqing Wang
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China.,Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yongwei Jia
- Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China.,Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Dave BR, Kulkarni M, Patidar V, Devanand D, Mayi S, Reddy C, Singh M, Rai RR, Krishnan A. Results of in situ fixation of Andersson lesion by posterior approach in 35 cases. Musculoskelet Surg 2022; 106:385-395. [PMID: 34037925 DOI: 10.1007/s12306-021-00712-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 05/11/2021] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE Due to the rarity of the Andersson lesion (AL), the literature is ambiguous regarding the type of surgical fixation, need for debridement and deformity correction. The purpose of this retrospective study is to evaluate the efficacy, feasibility and functional outcome of posterior fixation in AL. MATERIALS AND METHODS This study included 35 patients having thoracolumbar AL operated for in situ fixation and fusion with minimum of 24-month follow-up. VAS (Visual Analogue Score) back pain, ODI (Oswestry Disability Index), Frankel's grade were compared and analyzed. Union status was noted with complications. RESULTS The mean age of 35 patients was 56.34(± 11.3) years with average follow-up of 51.49 months. Two patients had AL at two levels. 27/37 AL were at discal level. Average estimated blood loss (EBL) was 276.43 ml and duration of surgery was 130.43 min. On an average, operated segments needed 7.77 screws. There were ten minor complications without long-term sequel. Neurological improvement was noted in 30 patients. Average preoperative VAS score improved from 8.69 to 3.14, ODI score improved from 68.76 to 18.77 at final follow-up which were significant (p < 0.05). There was significant improvement in Frankel's grading (Z = - 4.354, P = 0.00). CONCLUSIONS Surgical management of AL by posterior approach and posterior stabilization can give satisfactory results without the need of extensive anterior reconstruction, bone grafting or deformity correction procedures without added morbidity and complications.
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Affiliation(s)
- B R Dave
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - M Kulkarni
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - V Patidar
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - D Devanand
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - S Mayi
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - C Reddy
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - M Singh
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - R R Rai
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India
| | - A Krishnan
- Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Mithakhali, Ellisbridge, Ahmedabad, Gujarat, 380006, India.
- BIMS Hospital, Opp. Sir T Hospital, Near Charan Boarding, Jail Rd, Bhavnagar, Gujarat, 364001, India.
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Zhou H, Li X, Liu Y, Wang H, Jiang W. Surgical Treatment of Andersson Lesion of the Lumbar Spine with Minimal Invasion: A Case Report. Orthop Surg 2022; 14:3129-3133. [PMID: 36172923 DOI: 10.1111/os.13426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022] Open
Abstract
We present a 37-year-old female patient with AL of lumbar spine (L3-4) treated by OLIF combined with pedicle screw fixation (via Wiltse paraspinal approach) with relatively minimal invasion.
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Affiliation(s)
- Hong Zhou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuefeng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yijie Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Heng Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weimin Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Sudhakar PV, Kandwal P, Mch KA, Ifthekar S, Mittal S, Sarkar B. Management of Andersson lesions of spine: A systematic review of the existing literature. J Clin Orthop Trauma 2022; 29:101878. [PMID: 35510148 PMCID: PMC9058944 DOI: 10.1016/j.jcot.2022.101878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/05/2022] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Andersson lesions also termed as aseptic spondylodiscitis, spinal pseudoarthrosis are known to occur in patients with ankylosing spondylitis. Trauma as well as inflammation has been cited as factors responsible for the causation of these lesions. A variety of surgical approaches have been described in the literature such as anterior, posterior, combined anterior and posterior, with or without reconstruction of the anterior column defect. Controversy still exists regarding the optimal management these lesions. OBJECTIVE To address the optimal method of management, levels of instrumentation, requirement of fusion and anterior instrumentation and general epidemiological profile of the patients with Andersson lesions. MATERIALS AND METHODS An electronic search for studies on the surgical management of Andersson lesions of spine was performed. Quality assessment of the included articles was done by two independent authors according to the criteria used by researchers previously in systematic reviews. RESULTS Males were found to have an increased incidence with the thoracolumbar junction being the most common level. Posterior approach was the most favoured with reconstruction of the gap in the anterior column. Posterior osteotomy with correction of deformity was done commonly for an optimal healing environment. Instrumenting 2-3 levels above and below the lesion is favoured by most. CONCLUSION Conservative management for Andersson lesions can be employed in the setting of acute trauma and stable fractures involving a single column. Surgical management of these lesions with a posterior long segment fixation and anterior column reconstruction is the favoured treatment in majority of the cases.
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Affiliation(s)
- P. Venkata Sudhakar
- Dept. of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pankaj Kandwal
- Dept. of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
- Corresponding author. Professor and Head, Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Kaustubh Ahuja Mch
- Dept. of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Syed Ifthekar
- Dept. of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Samarth Mittal
- Dept. of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhaskar Sarkar
- Department of Trauma Surgery, AIIMS Rishikesh, Uttarakhand, India
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Peng YJ, Zhou Z, Wang QL, Liu XF, Yan J. Ankylosing spondylitis complicated with andersson lesion in the lower cervical spine: A case report. World J Clin Cases 2022; 10:3533-3540. [PMID: 35611204 PMCID: PMC9048539 DOI: 10.12998/wjcc.v10.i11.3533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 12/18/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Andersson lesion (AL) is an uncommon complication in ankylosing spondylitis (AS), which is characterized by nonneoplastic bone destruction and often appears as bone destruction and sclerosis in the vertebral body and/or the area involving the intervertebral disc. According to the literature, Andersson lesion commonly occur in the thoracic and lumbar spine and rarely in the cervical spine.
CASE SUMMARY This case involved a 78-year-old man with a long history of AS who developed AL in the cervical spine (C5/6 and C6/7). One-stage anterior-posterior approach surgery was successfully performed. At the 6-month follow-up, the pain was significantly reduced, and the limb function was gradually improved.
CONCLUSION AL uncharacteristically appears in the cervical spine and tends to be misdiagnosed as vertebral metastases or spinal tuberculosis. Posterior combined with anterior surgery achieves solid biological stabilization in the treatment of AL bone destruction.
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Affiliation(s)
- Yu-Jian Peng
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
| | - Zhuang Zhou
- Department of Pain, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
| | - Qian-Liang Wang
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
| | - Xiao-Feng Liu
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
| | - Jun Yan
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
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A modified posterior wedge osteotomy with interbody fusion for the treatment of thoracolumbar kyphosis with Andersson lesions in ankylosing spondylitis: a 5-year follow-up study. Chin Med J (Engl) 2020; 133:165-173. [PMID: 31929366 PMCID: PMC7028175 DOI: 10.1097/cm9.0000000000000594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Andersson lesions (ALs), also known as spondylodiscities, destructive vertebral lesions and spinal pseudarthrosis, usually occur in patients with ankylosing spondylitis (AS). Inflammatory and traumatic causes have been proposed to define this lesion. Different surgical approaches including anterior, posterior, and combined anterior and posterior procedure have been used to address the complications, consisting of mechanical pain, kyphotic deformity, and neurologic deficits. However, the preferred surgical procedure remains controversial. The aim of this study was to illustrate the safety, efficacy, and feasibility of a modified posterior wedge osteotomy for the ALs with kyphotic deformity in AS. Methods From June 2008 to January 2013, 23 patients (18 males, 5 females) at an average age of 44.8 years (range 25–69 years) were surgically treated for thoracolumbar kyphosis with ALs in AS via a modified posterior wedge osteotomy in our department. All sagittal balance parameters were assessed by standing lateral radiography of the whole spine before surgery and during the follow-up period. Assessment of radiologic fusion at follow-up was based on the Bridwell interbody fusion grading system. Ankylosing spondylitis quality of life (ASQoL) and visual analog scale (VAS) scores were performed to evaluate improvements in daily life function and back pain pre-operatively and post-operatively. Paired t tests were used to compare clinical data change in parametric values before and after surgery and the Mann-Whitney U test was employed for non-parametric comparisons. The radiographic data change was evaluated by repeated measure analysis of variance. Results The mean operative duration was 205.4 min (range 115–375 min), with an average blood loss of 488.5 mL (range 215–880 mL). Radiographical and clinical outcomes were assessed after a mean of 61.4 months of follow-up. The VAS back pain and ASQoL scores improved significantly in all patients (7.52 ± 1.31 vs. 1.70 ± 0.70, t = 18.30, P < 0.001; 13.87 ± 1.89 vs. 7.22 ± 1.24, t = 18.53, P < 0.001, respectively). The thoracolumbar kyphosis (TLK) changed from 40.03 ± 17.61° pre-operatively to 13.86 ± 6.65° post-operatively, and 28.45 ± 6.63° at final follow-up (F = 57.54, P < 0.001), the thoracic kyphosis (TK) changed from 52.30 ± 17.62° pre-operatively to 27.76 ± 6.50° post-operatively, and 28.45 ± 6.63° at final follow-up (F = 57.29, P < 0.001), and lumbar lordosis (LL) changed from −29.56 ± 9.73° pre-operatively to −20.58 ± 9.71° post-operatively, and −20.73 ± 10.27° at final follow-up (F = 42.50, P < 0.001). Mean sagittal vertical axis (SVA) was improved from 11.82 ± 4.55 cm pre-operatively to 5.12 ± 2.42 cm post-operatively, and 5.03 ± 2.29 cm at final follow-up (F = 79.36, P < 0.001). No obvious loss of correction occurred, according to the lack of significant differences in the sagittal balance parameters between post-operatively and the final follow-up in all patients (TK: 27.76 ± 6.50° vs. 28.45 ± 6.63°, TLK: 13.86 ± 6.65° vs. 14.42 ± 6.7°, LL: −20.58 ± 9.71° vs. −20.73 ± 10.27°, and SVA: 5.12 ± 2.42 cm vs. 5.03 ± 2.29 cm, all P > 0.05, respectively). Conclusions The modified posterior wedge osteotomy is an accepted surgical procedure for treating thoracolumbar kyphosis with ALs in AS and results in satisfactory local kyphosis correction, solid fusion, and good clinical outcomes.
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Wu M, Yan F, Ping A, Lei J. Effects of Andersson lesion treatment in ankylosing spondylitis: A medical record review study focused on medium- to long-term outcomes. Int J Rheum Dis 2020; 23:753-762. [PMID: 32266777 DOI: 10.1111/1756-185x.13826] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/05/2019] [Accepted: 03/04/2020] [Indexed: 12/13/2022]
Abstract
The present study aimed to evaluate the clinical efficacy of Andersson lesion (AL) treatments and prognostic factors using medium- to long-term follow-up data and discuss the clinical characteristics and treatment of AL. Forty-eight consecutive AL cases at our center from June 2011 to March 2018 were retrospectively analyzed, including 13 cases treated conservatively and 35 treated surgically. Epidemiological characteristics, treatment modalities, clinical features and outcomes, and prognostic factors of the Japanese Orthopaedic Association (JOA) recovery rate were reviewed. Neurological functional recovery was evaluated by American Spinal Injury Association (ASIA) classification. Clinical efficacy was evaluated by JOA score, visual analog scale (VAS) score, and Cobb's angle. The mean overall follow-up duration was 44.5±18.5 months (range, 27-85 months). There were 36 male and 12 female patients, with a mean age of 49.4±13.1 years (range, 26-72 years). The most common lesion location was the thoracolumbar region, i.e., T10-L2 (n=33; 68.8%), followed by the thoracic (n=10) and lumbar (n=5) regions. Patients treated surgically showed significantly better JOA scores, VAS scores and Cobb's angles at the final follow-up than did patients treated conservatively (P<.05). Univariate and binary logistic regression analyses identified two prognostic factors of the JOA score recovery rate: treatment modality (OR=0.157; 95%CI, 0.028-0.89; P=.036) and bone fusion (OR=9.965; 95%CI, 2.052-48.387; P=.004). Conservative treatment and bone nonunion predict worse JOA score recovery. Surgery remains the optimal treatment for AL in ankylosing spondylitis patients, with better clinical efficacy demonstrated by medium- to long-term follow-up data.
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Affiliation(s)
- Minhao Wu
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Feifei Yan
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ansong Ping
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Lei
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, Wuhan, China
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McKenna SP. It is time for an organised, scientific approach to the application of patient-reported outcome measures in clinical studies and trials. Clin Rheumatol 2018; 38:611-615. [PMID: 30564944 DOI: 10.1007/s10067-018-04403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
Too often, clinicians and researchers assume that patient-reported outcome measures (PROMs) are simply designed, can be changed to suit specific circumstances and should be freely available for use without seeking permission. If a version is not easily available, they believe they can produce a new translation without relevant experience or expertise. Copyright issues are inconvenient and commonly ignored, despite some journals requesting confirmation from authors that permission had been granted for use of copyrighted materials. When informed that authors of an article did not have such permission, the response from an editor was that nothing could be done as he had to rely on the word of the authors.In fact, high quality PROMs are carefully designed, developed for new cultures by means of proven standardised methodologies, carefully re-validated in the new culture and then administered by a responsible organisation to ensure that they are used appropriately in studies. If such care has not been taken, questions should be raised about the quality of the measure and the information it generates.Several problems have arisen with the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL). This is probably because it is recognised as the most appropriate measure of quality of life for people with Ankylosing Spondylitis and has been widely used in international clinical trials and studies. Fifty-seven official language adaptations of the questionnaire have been produced. Unfortunately, as a result of unauthorised adaptation and use, questions are raised about the validity of several publications that have used the ASQoL.
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Affiliation(s)
- Stephen P McKenna
- Galen Research, Manchester, UK.
- School of Health Sciences, University of Manchester, Manchester, UK.
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Shaik I, Bhojraj SY, Prasad G, Nagad PB, Patel PM, Kashikar AD, Kumar N. Management of Andersson Lesion in Ankylosing Spondylitis Using the Posterior-Only Approach: A Case Series of 18 Patients. Asian Spine J 2018; 12:1017-1027. [PMID: 30322255 PMCID: PMC6284118 DOI: 10.31616/asj.2018.12.6.1017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/17/2018] [Indexed: 12/20/2022] Open
Abstract
Study Design This retrospective study was conducted including 18 patients who underwent posterior-only stabilization and fusion procedure for pseudoarthrosis in the ankylosed spine from October 2007 to May 2015. Purpose This study aimed to describe the treatment outcomes in 18 patients with Andersson lesion (AL) who were managed using the posterior-only approach. Literature Review AL is an unstable, localized, vertebral, or discovertebral lesion of the spine. It is observed in patients with ankylosing spondylitis. The exact etiology of this disorder remains unclear, and the treatment guidelines are not clearly described. Methods We analyzed 18 patients with AL who were treated with posterior long segment spinal fusion without any anterior interbody grafting or posterior osteotomy. Pre- and postoperative radiography, computed tomography, and recent follow-up images were examined. The pre- and postoperative Visual Analog Scale score and the Oswestry Disability Index score were evaluated for all patients. Whiteclouds’ outcome analysis criteria were applied at the follow-up. Moreover, at study completion, patient feedback was collected; all the patients were asked to provide their opinion regarding the surgery and were asked whether they would recommend this procedure to other patients and them self undergo the same procedure again if required. Results The most common site was the thoracolumbar junction. The symptom duration ranged from 1 month to 10 years preoperatively. Most patients experienced fusion by the end of 1 year, and the fusion mass could be observed as early as 4 months. Pseudoarthrosis void of up to 2.5 cm was noted to be healed in subsequent imaging. In addition, clinically, the patients reported good symptomatic relief. No patient required revision surgery. Whiteclouds’ outcome analysis score at the latest follow-up revealed good-to-excellent outcomes in all patients. Conclusions ALs can be treated using the posterior-only approach with long segment fixation and posterior spinal fusion. This is a safe, simple, and quick procedure that prevents the morbidity of anterior surgery.
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Affiliation(s)
- Ismail Shaik
- Department of Spine Surgery, Wockhardt Hospitals Limited, Mumbai, India
| | | | - Gautam Prasad
- Department of Spine Surgery, Paras HMRI Hospital, Patna, India
| | | | | | | | - Nishant Kumar
- Department of Spine Surgery, Wockhardt Hospitals Limited, Mumbai, India
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