Skip to main content

Advertisement

SpringerLink
Log in

Functional outcome after lumbar closing wedge osteotomy in ankylosing spondylitis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

This study entails a prospective evaluation of lumbar closing wedge osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. Twenty patients with a median age of 52 years (range, 26–70) underwent follow-up at one year. The lumbar closing wedge osteomtomy was stabilised by metallic rods fixed by transpedicular screws. Outcome measures were quality of life (EuroQol), occiput-to-wall distance, pain, fatigue, complications, technical and radiological evaluation. The technical result was good in 16 and fair in four patients; two had neuropraxia. The deformity was reduced an average of 17° (95% confidence interval 15–25°) at one-year follow-up. Pain during activity, pain at night, and fatigue were significantly reduced. EuroQol improved from 0.42 to 0.69 (p = 0.002) and occiput-to-wall distance from 26 to 18 cm (p = 0.005). Functional outcome was improved after lumbar closing wedge osteotomy in ankylosing spondylitis.

Résumé

Evaluation prospective d’une ostéotomie lombaire à foyer fermé pour correction de cyphose lombaire chez les patients présentant une spondylarthrite ankylosante. Matériel et méthode: 20 patients dont l’âge moyen était de 52 ans (entre 26 et 70 ans) ont été suivis pendant un an et demi. Les vertèbres lombaires ont été stabilisées par deux tiges métalliques fixées par des vis transpédiculaires. Le devenir des patients a été analysé selon les critères de vie EUROQOL, selon la déformation résiduelle, les douleurs, la fatigue, les complications et la radiologie. Résultats: les résultats ont été bons chez 16 patients et passables chez 4 patients qui présentaient des troubles neurologiques résiduels (neuropraxie). A un an de recul, a déformation a été réduite en moyenne de 17°. La douleur, l’activité et la fatigue ont été significativement diminuées. L’index d’EUROQOL amélioré de 0,42 à 0,69 (p = 0,002), la flèche de cyphose mesurée en C1 de 26 à 18 cm (p = 0,005). Conclusion: dans les spondylarthrite ankylosante, l’ostéotomie lombaire à foyer fermé peut améliorer le devenir fonctionnel des patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Berven SH, Deviren V, Smith JA, Emami A, Hu SS, Bradford DS (2001) Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine 26:2036–2043

    Article  PubMed  CAS  Google Scholar 

  2. Boonen A, de Vet H, van der Heijde D, van der Tempel H, van der Linden S (2001) Work status and its determinants among patients with ankylosing spondylitis. A systematic literature review. J Rheumatol 28:1056–1062

    PubMed  CAS  Google Scholar 

  3. Braun J, Bollow M, Remlinger G, Eggens U, Rudwalteit M, Distler A et al (1998) Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41:58–67

    Article  PubMed  CAS  Google Scholar 

  4. Brox JI, Staff PH, Ljunggren AE, Staff PH (1993) Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome). BMJ 307:899–903

    Article  PubMed  CAS  Google Scholar 

  5. Chang KW, Chen YY, Lin CC, Hsu HL, Pai KC (2005) Closing wedge osteotomy versus opening wedge osteotomy in ankylosing spondylitis with thoracolumbar kyphotic deformity. Spine 30:1584–1593

    Article  PubMed  Google Scholar 

  6. Derogatis LR, Lipman RS, Rickels K, Uhlenut EH, Cori L (1974) The Hopkins Symptom Checklist (HSCL): a self-report inventory. Behav Sci 19:1–15

    Article  PubMed  CAS  Google Scholar 

  7. EuroQolGroup (1990) EuroQol—a new facility for the measurement of health related quality of life. Health Policy 16:199–208

    Article  Google Scholar 

  8. Gran JT, Husby G (1984) Ankylosing spondylitis: a comparative study of patients in an epidemiological survey, and those admitted to a department of rheumatology. J Rheumatol 11:788–793

    PubMed  CAS  Google Scholar 

  9. Haywood KL, Garratt AM, Dziedzic K, Daves PT (2003) Patient centered assessment of ankylosing spondylitis-specific health related quality of life: evaluation of the patient generated index. J Rheumatol 30:764–773

    PubMed  Google Scholar 

  10. Halm H, Metzstavenhagen P, Zielke K (1995) Results of surgical correction of kyphotic deformities of the spine in ankylosing spondylitis on the basis of the modified arthritis impact measurement scales. Spine 20:1612–1619

    Article  PubMed  CAS  Google Scholar 

  11. Heuft-Dorenbosch L, Vosse D, Landewe R, Spoorenberg A, Dougdos M, Mielants H (2004) Measurement of spinal mobility in ankylosing spondylitis: comparison of occiput-to-wall and tragus-to-wall distance. J Rheumatol 31:1779–1784

    PubMed  Google Scholar 

  12. Holm I, Friis A, Storheim K, Brox JI (2003) Measuring self-reported functional status and pain in patients with chronic low back pain by postal questionnaires. A reliability study. Spine 28:828–833

    Article  PubMed  Google Scholar 

  13. 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 27:612–618

    Article  PubMed  Google Scholar 

  14. Polly DW, Kilkelly FX, Mchale KA, Asplund LM, Mulligan M, Chang AS (1996) Measurement of lumbar lordosis: evaluation of intraobserver, interobserver, and technique variability. Spine 21:1530–1535

    Article  PubMed  Google Scholar 

  15. Rahali-Khachlouf H, Poiraudeau S, Fermanian J, Ben Saleh FZ, Dziri C, Revel M (2001) Validite et reproductibilite des mesures cliniques rachidiennes dans la spondylarthrite ankylosante. Ann Readapt Med Phys 44:205–212

    PubMed  CAS  Google Scholar 

  16. Ratcliffe J, Longworth L, Young T, Bryan S, Burroughs A, Bryan S (2002) Assessing health-related quality of life pre- and post-liver transplantation: a prospective multicenter study. Liver Transpl 8:263–270

    Article  PubMed  Google Scholar 

  17. Saraux A, Guedes C, Allain J, Devauchelle V, Valls I, Lamour A et al (1999) Prevalence of rheumatoid arthritis and spondyloarthropathy in Brittany, France. J Rheumatol 26:2622–2627

    PubMed  CAS  Google Scholar 

  18. Tosteson ANA (2000) Preference-based health outcome measures in low back pain. Spine 25:3161–3166

    Article  PubMed  CAS  Google Scholar 

  19. van der Linden S, Valkenburg H, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 27:361–368

    Article  PubMed  Google Scholar 

  20. van Royen BJ, De Gast D (1999) Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis 58:399–406

    Article  PubMed  Google Scholar 

  21. Ward MM (1999) Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res 12:247–255

    Article  PubMed  CAS  Google Scholar 

  22. WHO (2002) ATC index with DDDs. Who Collaborating Centre for Drug Statistics Methodology, Oslo, Norway

    Google Scholar 

  23. Willems KF, Slot GH, Anderson PG, Pavlov PM, de Kleuver M (2005) Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year. Spine 30:101–107

    PubMed  Google Scholar 

  24. Zink A, Braun J, Listing J, Wollenhaupt J (2000) Disability and handicap in rheumatoid arthritis and ankylosing spondylitis—results from the German rheumatological database. J Rheumaol 27:613–622

    CAS  Google Scholar 

  25. Zochling J, van der HD, Burgos-Vargas R, Collantes E, Davis JC, Dijkmans B et al (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65:442–452

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank the patients who participated in the study and the nurses and nurse aids at the hospital departments and outpatient clinics.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Rikshospitalet University Hospital and Medical Faculty, University of Oslo, Oslo, Norway

    Jens Ivar Brox, Roger Sørensen, Rolf Riise & Olav Reikerås

  2. Department of Anesthesiology, Rikshospitalet University Hospital and Medical Faculty, University of Oslo, Oslo, Norway

    Arthur Helle

  3. Department of Radiology, Rikshospitalet University Hospital and Medical Faculty, University of Oslo, Oslo, Norway

    Ragnhild Gunderson

Authors
  1. Jens Ivar Brox
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arthur Helle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roger Sørensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ragnhild Gunderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rolf Riise
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Olav Reikerås
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jens Ivar Brox.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brox, J.I., Helle, A., Sørensen, R. et al. Functional outcome after lumbar closing wedge osteotomy in ankylosing spondylitis. International Orthopaedics (SICOT) 33, 1049–1053 (2009). https://doi.org/10.1007/s00264-008-0590-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-008-0590-3

Keywords

Search

Navigation