Li Songke, Chen Liuxu, Ye Fei, Yuan Hao, Chen Zan, He Peifeng, Feng Daxiong
Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China; Southwest Medical University, Luzhou, People's Republic of China.
Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China.
World Neurosurg. 2023 May;173:176-187.e1. doi: 10.1016/j.wneu.2023.01.101. Epub 2023 Feb 2.
One- and two-level osteotomies have been used to treat thoracolumbar kyphosis in patients with ankylosing spondylitis (AS). However, the effectiveness and safety of the 2 methods have not been systematically compared, and few studies have reported on which method might be more suitable for treating AS.
We performed a systematic literature search. All comparative studies of one- and two-level osteotomy for the treatment of thoracolumbar kyphosis caused by AS were included. Efficacy was determined by the radiographic outcomes, including global kyphosis, sagittal vertical axis, and lumbar lordosis and the Oswestry disability index. The complication rates were used to assess the safety. We analyzed the data using Review Manager software.
A total of 10 studies were included and used for the meta-analysis. We pooled the studies according to the type of data they had reported to evaluate the radiographic correction and incidence of complications. We found that two-level osteotomy provided advantages compared with one-level osteotomy for spinal correction, including global kyphosis and lumbar lordosis. However, the correction was dependent on the degree of preoperative kyphosis. In addition, we found no differences between the 2 groups in the correction of the sagittal vertical axis or improvement in the Oswestry disability index. However, we did find differences in the incidence of neural complications, dural tear, and operative site infection.
Our findings have shown that one-level osteotomy is safer than two-level osteotomy. For AS patients with nonsevere kyphosis, one-level osteotomy will be sufficient for spinal sequence correction and maintenance of balance, and two-level osteotomy will not be needed. For AS patients with severe kyphosis, two-level osteotomy can be recommended for better orthopedic effects; however, a careful surgical technique is required.
单节段和双节段截骨术已被用于治疗强直性脊柱炎（AS）患者的胸腰椎后凸畸形。然而，这两种方法的有效性和安全性尚未得到系统比较，很少有研究报道哪种方法可能更适合治疗AS。
我们进行了系统的文献检索。纳入所有比较单节段和双节段截骨术治疗AS所致胸腰椎后凸畸形的研究。疗效由影像学结果决定，包括整体后凸、矢状垂直轴、腰椎前凸和Oswestry功能障碍指数。并发症发生率用于评估安全性。我们使用Review Manager软件分析数据。
共纳入10项研究并用于荟萃分析。我们根据所报告的数据类型对研究进行汇总，以评估影像学矫正和并发症发生率。我们发现，与单节段截骨术相比，双节段截骨术在脊柱矫正方面具有优势，包括整体后凸和腰椎前凸。然而，矫正程度取决于术前后凸的程度。此外，我们发现两组在矢状垂直轴矫正或Oswestry功能障碍指数改善方面没有差异。然而，我们确实发现神经并发症、硬脊膜撕裂和手术部位感染的发生率存在差异。
我们的研究结果表明，单节段截骨术比双节段截骨术更安全。对于非严重后凸畸形的AS患者，单节段截骨术足以矫正脊柱序列并维持平衡，无需双节段截骨术。对于严重后凸畸形的AS患者，可推荐双节段截骨术以获得更好的矫形效果；然而，需要谨慎操作手术技术。
