Wang Ting, Wang Dechun, Cong Yanan, Yin Chuqiang, Li Shuzhong, Chen Xiaoliang
Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
Clin Spine Surg. 2017 Feb;30(1):E13-E18. doi: 10.1097/BSD.0000000000000171.
Retrospective study of a posterior approach for surgical treatment of thoracolumbar pseudarthrosis in ankylosing spondylitis (AS).
The aim of the current study was to report the surgical results of symptomatic thoracolumbar pseudarthrosis in AS through a posterior approach.
Spinal pseudarthrosis is a well-known complication in AS. The condition may complicate with mechanical back pain, spinal deformity, and sometimes neurological deficits. Conservative treatment often fails in this situation and surgical treatment is required. However, the optimal surgical procedure for this condition is still controversial.
From January 2006 to December 2011, 12 AS patients with spinal pseudarthrosis at the thoracolumbar segment were treated surgically after failure of >3 months conservative treatment. The indications for surgery were persisting back pain in all patients, combined with neurological deficits in 4 patients and spinal deformities in 3 patients. Transforaminal or transpedicular debridement of the pseudarthrosis at the anterior column was performed from a posterior approach. After complete debridement, bone graft at the anterior open wedge defect of the pseudarthrosis was performed from a posterior approach. Posterior pedicle screws were placed for fixation. Clinical and radiographic outcomes were assessed with an average follow-up of 28 months (range, 24-36 mo).
The persistent back pain obtained significant relief in all cases after surgery. Four patients with neurological deficits showed complete recovery of neurological function at follow-up. The spinal deformities in 3 cases obtained correction. Solid bony fusion was achieved in all cases, and there was no correction loss at follow-up.
In AS with symptomatic thoracolumbar pseudarthrosis, a posterior transforaminal or transpedicular approach can provide circumferential stability, anterior bone graft, and neurological decompression simultaneously. A supplemental anterior approach may be avoided by this method.
对强直性脊柱炎（AS）胸腰椎假关节手术治疗的后路手术进行回顾性研究。
本研究旨在报告通过后路手术治疗AS有症状胸腰椎假关节的手术结果。
脊柱假关节是AS中一种众所周知的并发症。该病症可能并发机械性背痛、脊柱畸形，有时还会出现神经功能缺损。在这种情况下，保守治疗往往无效，需要进行手术治疗。然而，针对这种病症的最佳手术方法仍存在争议。
2006年1月至2011年12月，12例胸腰椎节段脊柱假关节的AS患者在保守治疗超过3个月失败后接受手术治疗。所有患者的手术指征均为持续性背痛，4例合并神经功能缺损，3例合并脊柱畸形。通过后路对假关节在前柱的椎间孔或经椎弓根进行清创。彻底清创后，通过后路在假关节的前开放楔形缺损处进行植骨。置入后路椎弓根螺钉进行固定。平均随访28个月（范围24 - 36个月）评估临床和影像学结果。
所有病例术后持续性背痛均得到显著缓解。4例神经功能缺损患者在随访时神经功能完全恢复。3例脊柱畸形得到矫正。所有病例均实现了牢固的骨融合，随访时无矫正丢失。
对于有症状的AS胸腰椎假关节，后路椎间孔或经椎弓根入路可同时提供环形稳定性、前路植骨和神经减压。采用这种方法可避免辅助前路手术。
