The skipping double-segmental transpedicular osteotomy and long segment pedicle screw fixation for ankylosing spondylitis thoracolumbar kyphosis deformity

English Keywords:Ankylosing spondylitis  Kyphosis  Thoracolumbar  Osteotomy  Internal fixation

English Abstract:

  【Abstract】 Objectives: To evaluate the safety and efficacy of the skipping double-segmental transpedicular osteotomy and long segment pedicle screw fixation in ankylosing spondylitis(AS) thoracolumbar kyphosis deformity. Methods: Twenty-five AS patients with thoracolumbar kyphosis were treated by skipping double-segmental transpedicular osteotomy and long segment pedicle screw fixation from October 2011 to October 2015. The patients were all male with a mean age of 39.0±7.2 years. The preoperative and postoperative data were collected: thoracolumbar kyphosis, lumbar lordosis, chin-brow angle, the sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), the Oswestry disability index(ODI). The operation time, intraoperative blood loss and complications were recorded. Results: All the surgeries went well with a mean operation time of 396.4±51.5min and a mean intraoperative blood loss of 1612.0±490.2ml. Mild dural ruptures occurred in 2 patients which were repaired and no cerebrospinal fluid leakage was found after operation. There were no serious complications in all the patients. The patients were followed up for a mean time of 19.0±6.6 months. The patients′ activity ability and life quality improved obviously. ODI at 6 months after operation and at the last follow-up was 8.5±3.6 points and 6.8±5.0 points, which all obviously reduced when compared with preoperative ODI of 33.9±6.5 points(P<0.05). Meanwhile, there was a significant difference between ODI at 6 months after operation and that at the last follow-up. The chin-brow angle, thoracolumbar kyphosis angle, lumbar lordosis angle, SVA, PT and SS at 2 weeks after operation and at the last follow-up had significant differences(P<0.05), but the PI between at the two time points had no statistically significant difference(P＞0.05). There were significant differences of chin-brow angle, thoracolumbar kyphosis angle, lumbar lordosis angle, SVA and PT between 2 weeks after operation and the last follow-up(P<0.05), but there was no significant difference of SS or PI between the two time points(P＞0.05). At the last follow-up, no failure of internal fixation was found, and all the bone grafts were solidly fused. Conclusions: The skipping double-segmental transpedicular osteotomy and long segment pedicle screw fixation is a relatively safe and effective method for AS thoracolumbar kyphosis, but surgeons should follow indication strictly in surgical choice.