Advertisement

European Spine Journal

, Volume 19, Issue 1, pp 65–70 | Cite as

Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy

  • Romain DebargeEmail author
  • Guillaume Demey
  • Pierre Roussouly
Original Article

Abstract

This is a radiographic study of ankylosing spondylitis patients with severe fixed kyphotic deformity who underwent pedicle subtraction osteotomy. Our goal was to measure and validate new angle to assess global kyphosis and to evaluate the radiological outcomes after surgery. This is the first report which describes new angle to assess global kyphosis (T1-S1). Pre and postoperative controls were compared according to the Pelvic Incidence. The sagittal parameters ankylosing spondylitis patients were compared with 154 asymptomatic patients. In addition to the pelvic parameters and the C7 tilt, we used the spino-sacral angle. Pelvic incidence in ankylosing spondylitis patients was higher than asymptomatic population (61 vs. 51°). For a same tilt of C7 for both groups, the low pelvic incidence group had a lower sacral slope and pelvic tilt and a higher global kyphosis (spino-sacral angle = 90°) than the high pelvic incidence group (spino-sacral angle = 98°). In the adult volunteers, the C7 tilt and spino-sacral angle measured, respectively, 95 and 135°. The preoperative C7 tilt measured 73° and increased to 83° (p = 0.0025). The preoperative spino-sacral angle measured 96° and increased to 113.3° (p = 0.003). A low pelvic incidence pelvis has a lower sacral slope than in high pelvic incidence and can support a bigger kyphosis. All the parameters were improved by the pedicle subtraction osteotomy, but the average spino-sacral angle remained lower than the control group. When C7 tilt was useful to assess the improvement of the balance, SSA allowed a better evaluation of the correction of kyphosis itself.

Keywords

Kyphosis Ankylosing spondylitis Pedicle subtraction osteotomy Spino-sacral angle 

References

  1. 1.
    McMaster MJ, Coventry MB (1973) Spinal osteotomy in ankylosing spondylitis: technique, complications, and long-term results. Mayo Clin Proc 48:476–486PubMedGoogle Scholar
  2. 2.
    White AA 3rd, Panjabi MM, Thomas CL (1977) The clinical biomechanics of kyphotic deformities. Clin Orthop Relat Res 128:8–17PubMedGoogle Scholar
  3. 3.
    Berven SH, Deviren V, Smith JA et al (2001) Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine 26:2036–2043CrossRefPubMedGoogle Scholar
  4. 4.
    Kim KT, Suk KS, Cho YJ et al (2002) Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine 27:612–618CrossRefPubMedGoogle Scholar
  5. 5.
    Van Royen BJ, De Gast A, Smit TH (2000) Deformity planning for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Eur Spine J 9:492–498CrossRefPubMedGoogle Scholar
  6. 6.
    Van Royen BJ, Toussaint HM, Kingma I et al (1998) Accuracy of the sagittal vertical axis in a standing lateral radiograph as a measurement of balance in spinal deformities. Eur Spine J 7:408–412CrossRefPubMedGoogle Scholar
  7. 7.
    Camargo FP, Cordeiro EN, Napoli MM (1986) Corrective osteotomy of the spine in ankylosing spondylitis: experience with 66 cases. Clin Orthop Relat Res 208:157–167PubMedGoogle Scholar
  8. 8.
    Suk KS, Kim KT, Lee SH et al (2003) Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine 28:2001–2005CrossRefPubMedGoogle Scholar
  9. 9.
    Legaye J, Duval-Beaupere G, Hecquet J et al (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103CrossRefPubMedGoogle Scholar
  10. 10.
    Bridwell KH, Lewis SJ, Lenke LG et al (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85-A:454–463PubMedGoogle Scholar
  11. 11.
    Hehne HJ, Zielke K, Bohm H (1990) Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis: report on 177 cases. Clin Orthop Relat Res 258:49–55PubMedGoogle Scholar
  12. 12.
    McMaster MJ (1985) A technique for lumbar spinal osteotomy in ankylosing spondylitis. J Bone Joint Surg Br 67:204–210PubMedGoogle Scholar
  13. 13.
    Van Royen BJ, De Gast A (1999) Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a structured review of three methods of treatment. Ann Rheum Dis 58:399–406CrossRefPubMedGoogle Scholar
  14. 14.
    Van Royen BJ, Slot GH (1995) Closing-wedge posterior osteotomy for ankylosing spondylitis: partial corporectomy and transpedicular fixation in 22 cases. J Bone Joint Surg Br 77:117–121PubMedGoogle Scholar
  15. 15.
    Roussouly P, Gollogly S, Noseda O et al (2006) The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine 31:E320–E325CrossRefPubMedGoogle Scholar
  16. 16.
    Chen PQ (1988) Correction of kyphotic deformity in ankylosing spondylitis using multiple spinal osteotomy and Zielke’s VDS instruments. Taiwan yi xue hui za zhi 87:692–699PubMedGoogle Scholar
  17. 17.
    Bridwell KH, Lewis SJ, Edwards C et al (2003) Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine 28:2093–2101CrossRefPubMedGoogle Scholar
  18. 18.
    Van Royen BJ (2002) A new technique for correction of an iatrogenic extension deformity in ankylosing spondylitis. Spine 27:332–333CrossRefPubMedGoogle Scholar
  19. 19.
    Van Loon PJ, Van Stralen G, Van Loon CJ et al (2006) A pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of a rigid thoracolumbar hyperkyphosis; a preliminary report. Spine J 6:195–200CrossRefPubMedGoogle Scholar
  20. 20.
    Noun Z, Lapresle P, Missenard G (2001) Posterior lumbar osteotomy for flat back in adults. J Spinal Dis 14:311–316CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Romain Debarge
    • 1
    Email author
  • Guillaume Demey
    • 1
  • Pierre Roussouly
    • 1
  1. 1.The Department of Orthopedic SurgeryCentre des MassuesLyonFrance

Personalised recommendations