Change of aortic length after closing-opening wedge osteotomy for patients with ankylosing spondylitis with thoracolumbar kyphosis: a computed tomographic study.

STUDY DESIGN

A computed tomographic study.

OBJECTIVE

To investigate the change in aortic length in patients with ankylosing spondylitis (AS) with thoracolumbar kyphosis after closing-opening wedge osteotomy (COWO).

SUMMARY OF BACKGROUND DATA

Several previous studies reported that COWO can effectively correct severe thoracolumbar kyphosis caused by AS. However, one disadvantage of COWO is elongation of the aorta, which increases the risk of aortic injury. To date, no studies have analyzed the alteration in aortic length in patients with AS undergoing COWO for thoracolumbar kyphosis.

METHODS

A total of 21 consecutive patients with AS with a mean age of 38.9 years undergoing COWO for the correction of thoracolumbar kyphosis were retrospectively studied. Radiographical measurements included global kyphosis, thoracic kyphosis, lumbar lordosis, angle of fusion levels, local kyphosis, and anterior height of the osteotomized vertebra. The computed tomographic scans of the spine were used to measure the aortic diameter (at the site of the osteotomy) and length (the length between the superior endplate of the upper instrumented vertebra and the inferior endplate of L4).

RESULTS

The aortic length increased by an average of 2.2 cm postoperatively. Significant changes in global kyphosis, local kyphosis, angle of fusion levels, lumbar lordosis, anterior height of the osteotomized vertebra, and aortic diameter at the site of the osteotomy were observed (P < 0.01). Significant correlation was noted between aortic length and changes in global kyphosis (r = 0.525, P = 0.015), local kyphosis (r = 0.654, P = 0.001), angle of fusion levels (r = 0.634, P = 0.002), and lumbar lordosis (r = 0.538, P = 0.012).

CONCLUSION

Aortic lengthening after COWO for correction of kyphosis was quantitatively confirmed by this study. Spine surgeons should be aware of the potential risk for the development of aortic injury in patients with AS undergoing COWO for the correction of thoracolumbar kyphosis.

LEVEL OF EVIDENCE