Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321, Zhongshan Road, 210008, Nanjing, China.
Eur Spine J. 2012 Apr;21(4):711-8. doi: 10.1007/s00586-011-2054-5. Epub 2011 Nov 8.
Surgical treatment is mandatory for spinal pseudarthrosis in advanced ankylosing spondylitis (AS) patients with painful sagittal deformity and/or neurological deficits. However, the most effective and safe surgical procedure for AS-related symptomatic thoracolumbar pseudarthrosis is still controversial. The purpose of this study is to explore the outcomes of pedicle subtraction osteotomy (PSO) at the level of pseudarthrotic lesion combined with supplemental anterior fusion for patients suffering from kyphotic pseudarthrosis in AS.
Seven AS patients with thoracolumbar pseudarthrosis and kyphotic deformity were reviewed. There were 6 males and 1 female with a mean age of 41.7 years. All patients had back pain. Imaging findings demonstrated 3-column extensive discovertebral destruction in all patients. The preoperative global kyphosis averaged 75° (range, 37°-114°) with the apex at the level of pseudarthrosis. Three patients had incomplete neurological deficits (Frankel D) preoperatively. All patients underwent PSO at the level of pseudarthrosis in the first stage followed by supplemental anterior fusion in the second stage. Radiographic and clinical outcomes were assessed with an average follow-up of 38 months (range, 24-59 months). The visual analogue scale (VAS) was compared before surgery and at the final follow-up.
All patients showed significant pain relief postoperatively and were satisfied with the kyphosis correction as well. Solid bony fusion was shown at the final follow-up. Three patients with neurological deficits had complete recovery of neurological function. The global kyphosis was corrected from 75º to 30º, with a mean correction of 45º. The VAS showed significant improvement. No surgical complication was observed.
PSO can be safely performed through the site of pseudarthrotic lesion in AS patients with pseudarthrosis and kyphotic deformity. After PSO, supplemental anterior fusion is sometimes necessary to support the anterior and middle column in a second stage if there is a bone defect in the osteotomy site.
对于患有疼痛性矢状畸形和/或神经功能缺损的晚期强直性脊柱炎（AS）患者的脊柱假关节，手术治疗是强制性的。然而，对于 AS 相关症状性胸腰椎假关节，最有效和安全的手术方法仍存在争议。本研究旨在探讨在 AS 患者假关节病变水平行椎弓根切除截骨术（PSO）结合补充前路融合治疗后凸性假关节的疗效。
回顾性分析 7 例 AS 合并胸腰椎假关节后凸畸形患者的临床资料。男 6 例，女 1 例，平均年龄 41.7 岁。所有患者均有腰背痛。影像学检查显示所有患者均存在 3 柱广泛的椎板破坏。术前全脊柱后凸角平均 75°（范围 37°-114°），顶点位于假关节水平。术前 3 例存在不完全性神经功能缺损（Frankel D 级）。所有患者一期均在假关节水平行 PSO，二期行补充前路融合。平均随访 38 个月（24-59 个月），评估影像学和临床疗效。采用视觉模拟评分（VAS）评估术前和末次随访时的腰痛程度。
所有患者术后腰痛均明显缓解，对后凸畸形矫正效果满意。末次随访时均获得骨性融合。3 例存在神经功能缺损的患者神经功能均完全恢复。全脊柱后凸角由术前的 75°矫正至术后的 30°，平均矫正 45°。VAS 评分明显改善。所有患者均未出现手术并发症。
AS 患者假关节合并后凸畸形时可安全地在假关节病变部位行 PSO，若截骨部位存在骨缺损，二期可通过补充前路融合来支撑前中柱。
