Zhou Lijin, Yang Honghao, Wang Jie, Zhang Yiqi, Wang Yunsheng, Hai Yong
Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
J Orthop Surg Res. 2025 Jul 19;20(1):679. doi: 10.1186/s13018-025-06074-7.
Ankylosing spondylitis (AS) often leads to severe thoracolumbar kyphotic deformity, requiring surgical correction. Pedicle subtraction osteotomy (PSO) is the gold standard but carries risks of significant blood loss and neurological complications. Posterior trans-intervertebral osteotomy (PTIO) has emerged as a less invasive alternative, but its comparative efficacy and safety remain unclear. This study aimed to compare radiographic outcomes, surgical parameters, and complications between PTIO and PSO in AS-related kyphosis.
A single-center retrospective cohort study included 45 AS patients with thoracolumbar kyphosis (19 PTIO, 26 PSO) who underwent posterior spinal correction. Radiographic parameters (global kyphosis GK, sagittal vertical axis SVA, etc.), surgical data (operative time, blood loss), health-related quality of life (SRS-22), and complications were analyzed. Statistical comparisons were performed using independent t-tests or Mann-Whitney U tests for continuous variables and chi-square/Fisher's tests for categorical variables.
Both groups achieved significant kyphosis correction, with no differences in postoperative GK (PTIO: 51.4° ± 13.3° vs. PSO: 47.4° ± 13.0°, P > 0.05) or SVA (PTIO: 59.1 ± 50.3 mm vs. PSO: 49.0 ± 47.1 mm, P > 0.05). PTIO showed lower intraoperative blood loss (600.9 ± 264.6 mL vs. 1088.7 ± 287.9 mL, P = 0.009) and fewer neurological complications (5.3% vs. 15.4%, P = 0.003). Health-related quality of life improved similarly in both groups (P > 0.05).
PTIO provides comparable radiographic correction to PSO while reducing blood loss and neurological risks. It represents a viable, less invasive alternative for AS-related kyphosis, particularly when anterior column support is achievable. Further studies with long-term follow-up are warranted to validate these findings.
强直性脊柱炎（AS）常导致严重的胸腰椎后凸畸形，需要手术矫正。经椎弓根截骨术（PSO）是金标准，但存在大量失血和神经并发症的风险。后路经椎间截骨术（PTIO）已成为一种侵入性较小的替代方法，但其相对疗效和安全性仍不明确。本研究旨在比较PTIO和PSO治疗AS相关后凸畸形的影像学结果、手术参数和并发症。
一项单中心回顾性队列研究纳入了45例接受后路脊柱矫正的AS胸腰椎后凸畸形患者（19例行PTIO，26例行PSO）。分析影像学参数（整体后凸GK、矢状垂直轴SVA等）、手术数据（手术时间、失血量）、健康相关生活质量（SRS-22）和并发症。连续变量采用独立t检验或Mann-Whitney U检验进行统计学比较，分类变量采用卡方检验/Fisher检验。
两组均实现了显著的后凸矫正，术后GK（PTIO：51.4°±13.3° vs. PSO：47.4°±13.0°，P>0.05）或SVA（PTIO：59.1±50.3 mm vs. PSO：49.0±47.1 mm，P>0.05）无差异。PTIO术中失血量较少（600.9±264.6 mL vs. 1088.7±287.9 mL，P=0.009），神经并发症较少（5.3% vs. 15.4%，P=0.003）。两组健康相关生活质量改善相似（P>0.05）。
PTIO与PSO在影像学矫正方面相当，同时减少了失血和神经风险。它是AS相关后凸畸形一种可行的、侵入性较小的替代方法，尤其是在前柱支撑可行时。有必要进行长期随访的进一步研究来验证这些发现。
