Department of Spine Surgery, The Third People's Hospital of Chengdu, Southwest Jiaotong University, #82 Qinglong Street, Chengdu, 610031, Sichuan, China.
J Orthop Surg Res. 2023 Jun 9;18(1):417. doi: 10.1186/s13018-023-03884-5.
Patients with severe kyphotic deformity (Cobb > 100°) secondary to ankylosing spondylitis (AS) occasionally cannot undergo corrective surgery in the prone position. Osteotomy in the lateral position might provide a possible solution. In this study, we aim to evaluate the clinical efficacy and safety of staged osteotomy in the lateral position for the treatment of AS-related severe kyphosis with a minimum of 2-year follow-up.
In total, 23 patients who underwent staged osteotomy in the lateral position from October 2015 to June 2017 were analyzed. In the first stage of surgery, all but one patient underwent a single-level Ponte osteotomy, which was followed by a pedicle subtraction osteotomy in the second stage. Mean follow-up was 30.8 ± 4.6 months. Global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), osteotomized vertebra intervertebral angle (OVI), chin-brow vertical angle (CBVA), Oswestry Disability Index (ODI) score and Scoliosis Research Society-22 Patient Questionnaire (SRS-22) were all compared pre- and postoperation.
All kyphosis parameters were significantly improved (all P < 0.05). GK was corrected from 115.0 ± 13.4° to 46.5 ± 9.0° postoperatively, with a mean correction of 68.5°. SVA was improved from 21.2 ± 5.1 cm to 5.1 ± 1.8 cm postoperatively. After surgery, CBVA was adjusted from 64.1 ± 23.2° to 5.7 ± 10.6° and OVI was changed from 9.0 ± 2.7° to - 20.1 ± 5.6°. Both the ODI and SRS-22 showed substantial improvements (all P < 0.05). Four patients with mild complications were observed perioperatively.
In AS patients with severe kyphosis, satisfactory correction can be safely achieved with staged osteotomy in the lateral position, which can not only correct the sagittal imbalance of the spine with acceptable complications but also facilitate the placement of the intraoperative position.
强直性脊柱炎（AS）导致的严重后凸畸形（Cobb>100°）患者偶尔无法在俯卧位接受矫形手术。侧卧位截骨术可能是一种可行的解决方案。本研究旨在评估侧卧位分期截骨术治疗强直性脊柱炎相关严重后凸畸形的临床疗效和安全性，随访时间至少 2 年。
2015 年 10 月至 2017 年 6 月，共 23 例患者接受侧卧位分期截骨术。在手术的第一阶段，除 1 例患者外，所有患者均接受单节段 Ponte 截骨术，随后在第二阶段行经椎弓根截骨术。平均随访时间为 30.8±4.6 个月。比较术前和术后的全局后凸角（GK）、胸椎后凸角（TK）、腰椎前凸角（LL）、矢状垂直轴（SVA）、截骨椎间隙角（OVI）、颏眉角（CBVA）、Oswestry 功能障碍指数（ODI）评分和脊柱侧凸研究协会 22 项患者问卷（SRS-22）。
所有后凸参数均明显改善（均 P<0.05）。术后 GK 从 115.0°±13.4°矫正至 46.5°±9.0°，平均矫正 68.5°。SVA 从 21.2±5.1cm 改善至 5.1±1.8cm。术后 CBVA 从 64.1°±23.2°调整至 5.7°±10.6°，OVI 从 9.0°±2.7°变为-20.1°±5.6°。ODI 和 SRS-22 均有显著改善（均 P<0.05）。4 例患者围手术期出现轻度并发症。
对于严重后凸畸形的 AS 患者，侧卧位分期截骨术可安全获得满意的矫正效果，不仅能纠正脊柱矢状失平衡，且并发症可接受，术中体位摆放也更方便。
