A modified posterior wedge osteotomy with interbody fusion for the treatment of thoracolumbar kyphosis with Andersson lesions in ankylosing spondylitis: a 5-year follow-up study.
A modified posterior wedge osteotomy with interbody fusion for the treatment of thoracolumbar kyphosis with Andersson lesions in ankylosing spondylitis: a 5-year follow-up study. Chin Med J (Engl). 2020 Jan 06;: Authors: Wei HY, Dong CK, Zhu YT, Zhou J, Yi P, Yang F, Tan MS Abstract BACKGROUND: Andersson lesions (ALs), also known as spondylodiscities, destructive vertebral lesions and spinal pseudarthrosis, usually occur in patients with ankylosing spondylitis (AS). Inflammatory and traumatic causes have been proposed to define this lesion. Different surgical approaches including anterior, posterior, and combined anterior and posterior procedure have been used to address the complications, consisting of mechanical pain, kyphotic deformity, and neurologic deficits. However, the preferred surgical procedure remains controversial. The aim of this study was to illustrate the safety, efficacy, and feasibility of a modified posterior wedge osteotomy for the ALs with kyphotic deformity in AS. METHODS: From June 2008 to January 2013, 23 patients (18 males, 5 females) at an average age of 44.8 years (range 25-69 years) were surgically treated for thoracolumbar kyphosis with ALs in AS via a modified posterior wedge osteotomy in our department. All sagittal balance parameters were assessed by standing lateral radiography of the whole spine before surgery and during the follow-up period. Assessment of radiologic fusion at follow-up was based on the Bridwell int...
ConclusionsThis study demonstrated a clear association between treatment agents and radiologic parameters in AS. Anti-TNF- α treatment improved LL with improvement in clinical outcomes. Lumbar lordosis was a significant predictor of clinical outcome in AS patients treated with anti-TNF-α.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.
Conclusion: Two-level PSO using a preoperative computer simulation is a feasible, safe, and effective technique for the treatment of severe thoracolumbar kyphosis in AS patients with normal cervical motion.
Authors: Rajoli SR, Kanna RM, Aiyer SN, Shetty AP, Rajasekaran S Abstract STUDY DESIGN: Retrospective case series. PURPOSE: To assess safety and efficacy of single stage, posterior stabilisation and anterior cage reconstruction through the transforaminal or lateral extra-cavitary route for Andersson lesions. OVERVIEW OF LITERATURE: Pseudoarthrosis in ankylosing spondylitis (Andersson lesion, AL) can cause progressive kyphosis and neurological deficit. Management involves early recognition and surgical stabilisation in patients with instability. However, the need and safety of anterior reconstruction of the ...
ConclusionsPatients with concomitant unilateral HOA and LBP showed a marked anteverted FNA in the arthritic hip and a spinopelvic misalignment. After THR, a relief of both hip and low back pain and a change in spinopelvic parameters is observed.
ConclusionsAS patients without deformity already have decreased paraspinal muscle volume compared with age and spinopelvic alignment matched non-AS patients with chronic back pain. Such decrease in paraspinal muscle volume was significantly associated with kyphotic deformity of AS patients even after multivariate adjustment. Although the result of our study supports the causal relationship between muscle degeneration and kyphotic deformity in AS patients, further study is required to prove the causality.
Surgical interventions are commonly advocated for correcting kyphotic deformities and relieving severe back pain in ankylosing spondylitis (AS) patients. The aim of this study was to evaluate the clinical outc...
A 64-year-old man, who had been diagnosed with ankylosing spondylitis(AS) for thirty years, presented with back pain, urinary incontinence, lower extremity paraparesis and hypoesthesia below L3 for 1 year. Lateral X-ray film of the whole spine showed typical AS with kyphosis deformity and the apical segment was T12, the sagittal plane image of spinal CT reconstruction revealed suspicious old fracture at T11-12 and several striped bony separation in the lumbar spinal canal. The X-ray film of pelvis showed bony fusion and stiffness at bilateral sacroiliac joints and hip joints (Figure 1).
A 58-year-old man was admitted to our hospital with back pain after falling and landing on his back. He had history of ankylosing spondilitis (AS). Physical examination revealed exaggerated dorsal kyphosis and tenderness to palpation of spine at thoracolumbar region. Radiographs of the thoracic and lumbar spine showed no evidence of fracture. Computerized tomography (CT) and magnetic resonance imaging (MRI) was performed. CT and MRI showed a horizontal fracture of the T11 vertebra, bamboo spine and fusion of sacroiliac joints (Fig 1).
Conclusion The transpedicular subtraction and disc resection osteotomy achieve satisfactory kyphosis correction, good fusion and favorable clinical outcomes with less blood loss and complications than other approaches, implying an alternative method in patients with Andersson lesion-complicating ankylosing spondylitis.
Conclusions Cervical sagittal parameters were found to be significantly different in AS patients and normal controls. Correlation analysis revealed significant relationships between radiographic parameters and QOL. In particular, C2–C7 SVA was found to be a significant predictor of QOL in AS patient.