Evaluation of pedicle subtraction osteotomy in the treatment of ankylosing spondylitis patients with thoracolumbar kyphosis and hiatus hernia

English Keywords:Ankylosing spondylitis  Thoracolumbar kyphosis  Hiatus hernia  Pedicle subtrction osteotomy  Anesthesia evaluation

English Abstract:

  【Abstract】 Objectives: To explore the clinical characteristics and imaging features of ankylosing spondylitis(AS) patients with thoracolumbar kyphosis and hiatus hernia, and to evaluate the outcomes of pedicle subtraction osteotomy(PSO) in such patients. Methods: The medical records of 301 AS patients with thoracolumbar kyphosis underwent PSO between January 2014 and July 2020 were reviewed. Among them, 5 were found with hiatus hernia(2 males and 3 females), averaged 54.6±7.2 years (48-67 years), and 2 of them were reported with dysphagia. And the preoperative pulmonary function examination was performed reporting 4 patients with mild respiratory function limitation and 1 with severe respiratory insufficiency and pulmonary hypertension. Hiatus hernia tissue was not treated specially during PSO. Global kyphosis(GK) and sagittal vertical axis(SVA) were measured in X-ray preoperatively, postoperatively and at the last follow-up, while the height and size of hiatus hernia were measured in CT scan before and after surgery. Complications were recorded after surgery. Rank-sum test was used to compare the preoperative and postoperative radiographic parameters. Results: All the 5 patients had a follow-up of 12.6±7.5 months(3-24 months). GK was corrected from 103.2°±19.9° to 48.2°±15.0°, and it was 45.0°±11.9° at the last follow-up. SVA was corrected from to 213.4±90.6mm to 68.2±36.0mm, and it was 63.0±50.3mm at the last follow-up. Significant differences were found in pre- and postoperative GK and SVA(P<0.05), while there was no statistical significance between those postoperatively and at the last follow-up(P>0.05). The height and size of hiatus hernia before operation were 9.1±1.7cm and 73.0±39.3cm2, and they decreased to 6.4±0.9cm and 42.4±19.5cm2 respectively after surgery. Significant difference swere found in preoperative and postoperative height and size of hiatus hernia(P<0.05). No neurological complications, superficial or deep infection, or implant related complications including screw breakage and rod fracture were found after surgery. Conclusions: Hiatal hernia can be ameliorated at the same time as the spinal deformity is corrected in AS patients with hiatus hernia after PSO.