The Management and Prevention of Complications

  • Tianhao Wang
  • Geng Cui
  • Guoquan Zheng


Spinal osteotomy for kyphotic deformity of ankylosing spondylitis (AS) has high risk due to large trauma, long operation time, and high difficulty of operation. It has been reported the incidence of complications is up to 40% [1, 2]. To manage and prevent complications is also crucial to the success of surgery. The complications are divided into intraoperative complications and postoperative complications. The former includes pedicle screw misplacement, blood loss, dura laceration/cerebrospinal fluid leakage, neurovascular injury, blindness, and sagittal translation [2–4]. The latter includes internal fixation failure, infection, pseudarthrosis, loss of correction, proximal junctional kyphosis/failure, and complications caused by changes in the volume of thoracic and abdominal cavity [3, 5–7]. With enhancement of ideas and techniques of spinal osteotomy, the effect of surgical correction for spinal kyphosis of AS has been greatly improved. The incidence of complications of pseudarthrosis and loss of correction is decreasing gradually. Instead, the reports for nerve injury and blood loss are increasing. Foreseeing the complications and comprehending how to prevent them can make the surgeons more confident, resulting in a better consequence for the patients [8].


  1. 1.
    Mundwiler ML, Siddique K, Dym JM, Perri B, Johnson JP, Weisman MH. Complications of the spine in ankylosing spondylitis with a focus on deformity correction. Neurosurg Focus. 2008;24:E6.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Yang BP, Ondra SL, Chen LA, Jung HS, Koski TR, Salehi SA. Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. J Neurosurg Spine. 2006;5:9–17.CrossRefPubMedGoogle Scholar
  3. 3.
    Chang KW, Chen YY, Lin CC, Hsu HL, Pai KC. Closing wedge osteotomy versus opening wedge osteotomy in ankylosing spondylitis with thoracolumbar kyphotic deformity. Spine (Phila Pa 1976). 2005;30:1584–93.CrossRefGoogle Scholar
  4. 4.
    Willems KF, Slot GH, Anderson PG, Pavlov PW, de Kleuver M. Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year. Spine (Phila Pa 1976). 2005;30:101–7.CrossRefGoogle Scholar
  5. 5.
    Fu J, Song K, Zhang YG, Zheng GQ, Zhang GY, Liu C, et al. Changes in cardiac function after pedicle subtraction osteotomy in patients with a kyphosis due to ankylosing spondylitis. Bone Joint J. 2015;97-B:1405–10.CrossRefPubMedGoogle Scholar
  6. 6.
    Liu C, Song K, Zhang Y, Fu J, Zheng G, Tang X, et al. Changes of the abdomen in patients with ankylosing spondylitis kyphosis. Spine (Phila Pa 1976). 2015;40:E43–8.CrossRefGoogle Scholar
  7. 7.
    Sugrue PA, O’Shaughnessy BA, Nasr F, Koski TR, Ondra SL. Abdominal complications following kyphosis correction in ankylosing spondylitis. J Neurosurg Spine. 2009;10:154–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Zhao Y, Wang Y, Wang Z, Zhang X, Mao K, Zhang Y. Effect and strategy of one-stage interrupted two-level transpedicular wedge osteotomy for correcting severe kyphotic deformities in ankylosing spondylitis. Clin Spine Surg. 2016;30(4):E454–9.CrossRefGoogle Scholar
  9. 9.
    Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman RA, Kim YJ, et al. Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976). 2007;32:2245–52.CrossRefGoogle Scholar
  10. 10.
    Van Royen BJ, De Gast A. Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis. 1999;58:399–406.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Wang Y, Zhang Y, Mao K, Zhang X, Wang Z, Zheng G, et al. Transpedicular bivertebrae wedge osteotomy and discectomy in lumbar spine for severe ankylosing spondylitis. J Spinal Disord Tech. 2010;23:186–91.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zhang X, Zhang Z, Wang J, Lu M, Hu W, Wang Y, et al. Vertebral column decancellation: a new spinal osteotomy technique for correcting rigid thoracolumbar kyphosis in patients with ankylosing spondylitis. Bone Joint J. 2016;98-B:672–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Zheng GQ, Song K, Zhang YG, Wang Y, Huang P, Zhang XS, et al. Two-level spinal osteotomy for severe thoracolumbar kyphosis in ankylosing spondylitis. Experience with 48 patients. Spine (Phila Pa 1976). 2014;39:1055–8.CrossRefGoogle Scholar
  14. 14.
    Zhu Z, Wang X, Qian B, Wang B, Yu Y, Zhao Q, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between Smith-Petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech. 2012;25:383–90.CrossRefPubMedGoogle Scholar
  15. 15.
    Chang KW, Chen HC, Chen YY, Lin CC, Hsu HL, Cai YH. Sagittal translation in opening wedge osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. Spine (Phila Pa 1976). 2006;31:1137–42.CrossRefGoogle Scholar
  16. 16.
    Arun R, Dabke HV, Mehdian H. Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction. Eur Spine J. 2011;20:2252–60.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Chiffolot X, Lemaire JP, Bogorin I, Steib JP. Pedicle closing-wedge osteotomy for the treatment of fixed sagittal imbalance. Rev Chir Orthop Reparatrice Appar Mot. 2006;92:257–65.CrossRefPubMedGoogle Scholar
  18. 18.
    Cho KJ, Bridwell KH, Lenke LG, Berra A, Baldus C. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976). 2005;30:2030–7. discussion 2038.CrossRefGoogle Scholar
  19. 19.
    Murrey DB, Brigham CD, Kiebzak GM, Finger F, Chewning SJ. Transpedicular decompression and pedicle subtraction osteotomy (eggshell procedure): a retrospective review of 59 patients. Spine (Phila Pa 1976). 2002;27:2338–45.CrossRefGoogle Scholar
  20. 20.
    Elwatidy S, Jamjoom Z, Elgamal E, Zakaria A, Turkistani A, El-Dawlatly A. Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebo-controlled study. Spine (Phila Pa 1976). 2008;33:2577–80.CrossRefGoogle Scholar
  21. 21.
    Baldus CR, Bridwell KH, Lenke LG, Okubadejo GO. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls. Spine (Phila Pa 1976). 2010;35:235–9.CrossRefGoogle Scholar
  22. 22.
    Chang KW, Tu MY, Huang HH, Chen HC, Chen YY, Lin CC. Posterior correction and fixation without anterior fusion for pseudoarthrosis with kyphotic deformity in ankylosing spondylitis. Spine (Phila Pa 1976). 2006;31:E408–13.CrossRefGoogle Scholar
  23. 23.
    Kiaer T, Gehrchen M. Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis. Eur Spine J. 2010;19:57–64.CrossRefPubMedGoogle Scholar
  24. 24.
    Paré PE, Chappuis JL, Rampersaud R, Agarwala AO, Perra JH, Erkan S, et al. Biomechanical evaluation of a novel fenestrated pedicle screw augmented with bone cement in osteoporotic spines. Spine (Phila Pa 1976). 2011;36:E1210–4.CrossRefGoogle Scholar
  25. 25.
    Wu ZX, Cui G, Lei W, Fan Y, Wan SY, Ma ZS, et al. Application of an expandable pedicle screw in the severe osteoporotic spine: a preliminary study. Clin Invest Med. 2010;33:E368–74.CrossRefPubMedGoogle Scholar
  26. 26.
    Wang T, Zhao Y, Liang Y, Zhang H, Wang Z, Wang Y. Risk factor analysis of proximal junctional kyphosis after posterior osteotomy in patients with ankylosing spondylitis. J Neurosurg Spine. 2018;29:75–80.CrossRefPubMedGoogle Scholar
  27. 27.
    Qiao M, Qian BP, Mao SH, Qiu Y, Wang B. The patterns of loss of correction after posterior wedge osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis: a minimum of five-year follow-up. BMC Musculoskelet Disord. 2017;18:465.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Tianhao Wang
    • 1
  • Geng Cui
    • 1
  • Guoquan Zheng
    • 1
  1. 1.Department of OrthopaedicsGeneral Hospital of Chinese PLABeijingChina

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