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Can acetabular orientation be restored by lumbar pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis?

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Abstract

Purpose

To evaluate whether acetabular orientation (abduction and anteversion) can be restored by lumbar pedicle subtraction osteotomy (PSO) in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis.

Materials and methods

A total of 33 consecutive AS patients with thoracolumbar kyphosis undergoing one-level lumbar PSO were retrospectively reviewed. Radiographical measurements included sagittal vertical axis, global kyphosis, thoracic kyphosis, local kyphosis, lumbar lordosis, pelvic incidence, sacral slope, and pelvic tilt. Acetabular abduction and anteversion were measured on CT scans of the pelvis before and after lumbar PSO. The preoperative and postoperative parameters were compared by the paired samples t test. Pearson’s correlation analysis was conducted to determine the correlations between the changes in acetabular abduction and anteversion and the changes in sagittal spinopelvic parameters.

Results

After lumbar PSO, sagittal vertical axis, global kyphosis, and pelvic tilt were corrected from 15.7 ± 6.7 cm, 66.8° ± 17.5°, and 38.6° ± 9.0° to 2.9 ± 4.9 cm, 21.3° ± 8.2°, and 23.2° ± 8.2°, respectively (p < 0.001). Of note, acetabular abduction and anteversion decreased from 59.6° ± 4.6° to 31.4° ± 6.5° before surgery to 51.4° ± 6.5° and 20.2° ± 4.4° after surgery, respectively (p < 0.001). Moreover, the changes in acetabular abduction and anteversion were observed significantly correlated with the change in pelvic tilt (r = 0.527, p = 0.002; r = 0.586, p < 0.001).

Conclusion

Abnormal acetabular abduction and anteversion could be corrected by lumbar PSO in AS patients with thoracolumbar kyphosis. Consequently, a relatively normal acetabular orientation could be achieved after lumbar PSO, which might decrease the potential risk of dislocation in AS patients with spine and hip deformities requiring subsequent THR surgery.

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References

  1. Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369:1379–1390. doi:10.1016/S0140-6736(07)60635-7

    Article  PubMed  Google Scholar 

  2. Qian BP, Jiang J, Qiu Y, Wang B, Yu Y, Zhu ZZ (2014) The presence of a negative sacral slope in patients with ankylosing spondylitis with severe thoracolumbar kyphosis. J Bone Joint Surg Am 96:e188. doi:10.2106/JBJS.M.01070

    Article  PubMed  Google Scholar 

  3. Debarge R, Demey G, Roussouly P (2011) Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J 20(Suppl 5):619–625. doi:10.1007/s00586-011-1929-9

    Article  PubMed  PubMed Central  Google Scholar 

  4. Qian BP, Qiu Y, Wang B, Sun X, Zhu ZZ, Jiang J, Ji ML (2012) Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis. Eur Spine J 21:711–718. doi:10.1007/s00586-011-2054-5

    Article  PubMed  Google Scholar 

  5. Sansur CA, Fu KM, Oskouian RJ Jr, Jagannathan J, Ct Kuntz, Shaffrey CI (2008) Surgical management of global sagittal deformity in ankylosing spondylitis. Neurosurg Focus 24:E8. doi:10.3171/FOC/2008/24/1/E8

    Article  PubMed  Google Scholar 

  6. Kim KT, Suk KS, Cho YJ, Hong GP, Park BJ (2002) Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine (Phila Pa 1976) 27:612-618

  7. Tang WM, Chiu KY (2000) Primary total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty 15:52–58

    Article  CAS  PubMed  Google Scholar 

  8. Joshi AB, Markovic L, Hardinge K, Murphy JC (2002) Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips. J Arthroplasty 17:427–433

    Article  PubMed  Google Scholar 

  9. Bhan S, Eachempati KK, Malhotra R (2008) Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Arthroplasty 23:859–866. doi:10.1016/j.arth.2007.07.014

    Article  PubMed  Google Scholar 

  10. Zheng GQ, Zhang YG, Chen JY, Wang Y (2014) Decision making regarding spinal osteotomy and total hip replacement for ankylosing spondylitis: experience with 28 patients. Bone Joint J 96-B:360–365. doi:10.1302/0301-620X.96B3.32774

  11. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220

    Article  CAS  PubMed  Google Scholar 

  12. Tang WM, Chiu KY, Kwan MF, Ng TP (2007) Sagittal pelvic mal-rotation and positioning of the acetabular component in total hip arthroplasty: three-dimensional computer model analysis. J Orthop Res 25:766–771. doi:10.1002/jor.20225

    Article  CAS  PubMed  Google Scholar 

  13. Lafage V, Schwab F, Vira S, Hart R, Burton D, Smith JS, Boachie-Adjei O, Shelokov A, Hostin R, Shaffrey CI, Gupta M, Akbarnia BA, Bess S, Farcy JP (2011) Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine 14:184–191. doi:10.3171/2010.9.SPINE10129

    Article  PubMed  Google Scholar 

  14. Qian BP, Wang XH, Qiu Y, Wang B, Zhu ZZ, Jiang J, Sun X (2012) The influence of closing-opening wedge osteotomy on sagittal balance in thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison with closing wedge osteotomy. Spine (Phila Pa 1976) 37:1415–1423. doi:10.1097/BRS.0b013e318250dc95

  15. Gill JB, Levin A, Burd T, Longley M (2008) Corrective osteotomies in spine surgery. J Bone Joint Surg Am 90:2509–2520. doi:10.2106/JBJS.H.00081

    Article  PubMed  Google Scholar 

  16. Qian BP, Jiang J, Qiu Y, Wang B, Yu Y, Zhu ZZ (2013) Radiographical predictors for postoperative sagittal imbalance in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis after lumbar pedicle subtraction osteotomy. Spine (Phila Pa 1976) 38:E1669–1675. doi:10.1097/BRS.0000000000000021

  17. Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Lubovsky O, Wright D, Hardisty M, Kiss A, Kreder H, Whyne C (2012) Acetabular orientation: anatomical and functional measurement. Int J Comput Assist Radiol Surg 7:233–240. doi:10.1007/s11548-011-0648-3

    Article  PubMed  Google Scholar 

  19. Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg Br 75:228–232

    Article  CAS  PubMed  Google Scholar 

  20. Stem ES, O’Connor MI, Kransdorf MJ, Crook J (2006) Computed tomography analysis of acetabular anteversion and abduction. Skeletal Radiol 35:385–389. doi:10.1007/s00256-006-0086-4

    Article  PubMed  Google Scholar 

  21. Murphy SB, Kijewski PK, Millis MB, Harless A (1990) Acetabular dysplasia in the adolescent and young adult. Clin Orthop Relat Res 214–223

  22. Hu X, Thapa AJ, Cai Z, Wang P, Huang L, Tang Y, Ye J, Cheng K, Shen H (2016) Comparison of smith-petersen osteotomy, pedicular subtraction osteotomy, and poly-segmental wedge osteotomy in treating rigid thoracolumbar kyphotic deformity in ankylosing spondylitis a systematic review and meta-analysis. BMC Surg 16:4. doi:10.1186/s12893-015-0118-x

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yildiz F, Akgul T, Ekinci M, Dikici F, Sar C, Domanic U (2016) Results of closing wedge osteotomy in the treatment of sagittal imbalance due to ankylosing spondylitis. Acta Orthop Traumatol Turc 50:63–68. doi:10.3944/AOTT.2016.14.0059

    PubMed  Google Scholar 

  24. Weinberg DS, Morris WZ, Gebhart JJ, Liu RW (2015) Pelvic incidence: an anatomic investigation of 880 cadaveric specimens. Eur Spine J. doi:10.1007/s00586-015-4317-z

    Google Scholar 

  25. Lee JH, Na KH, Kim JH, Jeong HY, Chang DG (2015) Is pelvic incidence a constant, as everyone knows? Changes of pelvic incidence in surgically corrected adult sagittal deformity. Eur Spine J. doi:10.1007/s00586-015-4199-0

  26. Dandachli W, Ul Islam S, Richards R, Hall-Craggs M, Witt J (2013) The influence of pelvic tilt on acetabular orientation and cover: a three-dimensional computerised tomography analysis. Hip Int 23:87–92. doi:10.5301/HIP.2013.10715

    Article  PubMed  Google Scholar 

  27. Masquefa T, Verdier N, Gille O, Boissiere L, Obeid I, Maillot C, Tournier C, Fabre T (2015) Change in acetabular version after lumbar pedicle subtraction osteotomy to correct post-operative flat back: EOS((R)) measurements of 38 acetabula. Orthop Traumatol Surg Res 101:655–659. doi:10.1016/j.otsr.2015.07.013

    Article  CAS  PubMed  Google Scholar 

  28. Sato T, Nakashima Y, Matsushita A, Fujii M, Iwamoto Y (2013) Effects of posterior pelvic tilt on anterior instability in total hip arthroplasty: a parametric experimental modeling evaluation. Clin Biomech 28:178–181. doi:10.1016/j.clinbiomech.2012.12.011

    Article  Google Scholar 

  29. Fujii M, Nakashima Y, Sato T, Akiyama M, Iwamoto Y (2012) Acetabular tilt correlates with acetabular version and coverage in hip dysplasia. Clin Orthop Relat Res 470:2827–2835. doi:10.1007/s11999-012-2370-z

    Article  PubMed  PubMed Central  Google Scholar 

  30. Buckland AJ, Vigdorchik J, Schwab FJ, Errico TJ, Lafage R, Ames C, Bess S, Smith J, Mundis GM, Lafage V (2015) Acetabular anteversion changes due to spinal deformity correction: bridging the gap between hip and spine surgeons. J Bone Joint Surg Am 97:1913–1920. doi:10.2106/jbjs.o.00276

    Article  PubMed  Google Scholar 

  31. Schroeder JE, Jerabek S, Sama A, Kaplan L, Girardi F, Lebl DR (2014) The effect of 3-column spinal osteotomy on anterior pelvic plane and acetabulum position. Am J Orthop (Belle Mead NJ) 43:E133–E136

    Google Scholar 

Download references

Acknowledgments

One of the authors (Bang-ping Qian) has received funding from the National Natural Science Foundation of China (81372009), Six Talent Peaks Foundation of Jiangsu Province (2012-WS-004), and the Fourth Period of “333” High-level Personnel Training Program of Jiangsu Province.

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Authors and Affiliations

  1. Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China

    Jun Hu, Bang-ping Qian, Yong Qiu, Bin Wang, Yang Yu, Ze-Zhang Zhu, Jun Jiang, Sai-hu Mao, Zhe Qu & Yun-peng Zhang

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  1. Jun Hu
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Correspondence to Bang-ping Qian.

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Hu, J., Qian, Bp., Qiu, Y. et al. Can acetabular orientation be restored by lumbar pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis?. Eur Spine J 26, 1826–1832 (2017). https://doi.org/10.1007/s00586-016-4709-8

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