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Risk factors of hip joint structural changes following pedicle subtraction osteotomy for ankylosing spondylitis-related thoracolumbar kyphosis: a minimum two-year observation

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Abstract

Purpose

To determine the clinical- and surgical-related factors of hip joint structural changes in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis who underwent PSO.

Methods

Hip involvement was assessed by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h) and defined by a score of at least 2. 52 patients with BASRI-h scores maintained and 78 patients with BASRI-h scores increased during follow-up were retrospectively reviewed. Clinical data were recorded. Radiological assessment was performed preoperatively, postoperatively, and at the final follow-up.

Results

No significant difference existed in age, gender and follow-up time between the groups, but earlier onset of AS, longer disease and kyphotic duration, and worse Bath Ankylosing Spondylitis Functional Index (BASFI) scores at the final follow-up were observed in patients with BASRI-h scores increased (P < 0.05). Besides, global kyphosis (GK), T1-pelvic angle (TPA), pelvic tilt (PT) and anterior pelvic plane angle (APPA) were always larger in patients with BASRI-h scores increased, accompanied with more sacral fixation (P < 0.05). Multivariate logistics regression showed that earlier onset of AS, longer kyphotic duration, larger preoperative GK, sacral fixation and larger APPA during follow-up were independent risk factors.

Conclusion

Earlier onset of AS and longer kyphotic duration were the clinical risk factors of hip joint structural changes in AS patients following PSO, while larger preoperative GK, sacral fixation in PSO and larger APPA during follow-up were the surgical-related factors. Surgeons should inform patients with risk factors of the possibility for severe hip joint structural changes after PSO.

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Acknowledgements

One of the authors (Bang-ping Qian) has received funding from the Jiangsu Provincial Medical Talent (RC2011147). Another author (Yong Qiu) has received 315 funding from the Jiangsu Provincial Key Medical Center (YXZXA2016009).

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Authors and Affiliations

  1. Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China

    Yao Li, Bang-ping Qian, Yong Qiu, Yang Yu & Bin Wang

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  1. Yao Li
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Correspondence to Bang-ping Qian.

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Li, Y., Qian, Bp., Qiu, Y. et al. Risk factors of hip joint structural changes following pedicle subtraction osteotomy for ankylosing spondylitis-related thoracolumbar kyphosis: a minimum two-year observation. Eur Spine J 32, 2293–2302 (2023). https://doi.org/10.1007/s00586-023-07726-0

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