Table E2 Results—opening versus Closing Wedge Osteotomy in Ankylosing Spondylitis

Abstract Study Design Systematic review. Study Rationale To seek out and assess the best quality evidence available comparing opening wedge osteotomy (OWO) and closing wedge osteotomy (CWO) in patients with ankylosing spondylitis to determine whether their results differ with regard to several different subjective and objective outcome measures. Objective The aim of this study is to determine whether there is a difference in subjective and objective outcomes when comparing CWO and OWO in patients with ankylosing spondylitis suffering from clinically significant thoracolumbar kyphosis with respect to quality-of-life assessments, complication risks, and the amount of correction of the spine achieved at follow-up. Methods A systematic review was undertaken of articles published up to July 2012. Electronic databases and reference lists of key articles were searched to identify studies comparing effectiveness and safety outcomes between adult patients with ankylosing spondylitis who received closing wedge versus opening wedge osteotomies. Studies that included pediatric patients, polysegmental osteotomies, or revision procedures were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results From a total of 67 possible citations, 4 retrospective cohorts (class of evidence III) met our inclusion criteria and form the basis for this report. No differences in Oswestry Disability Index, visual analog scale for pain, Scoliosis Research Society (SRS)-24 score, SRS-22 score, and patient satisfaction were reported between the closing and opening wedge groups across two studies. Regarding radiological outcomes following closing versus opening osteotomies, mean change in sagittal vertical axis ranged from 8.9 to 10.8 cm and 8.0 to 10.9 cm, respectively, across three studies; mean change in lumbar lordosis ranged from 36 to 47 degrees and 19 to 41 degrees across four studies; and mean change in global kyphosis ranged from 38 to 40 degrees and 28 to 35 degrees across two studies. Across all studies, overall complication risks ranged from 0 to 16.7% following CWO and from 0 to 23.6% following OWO. Conclusion No statistically significant differences were seen in patient-reported or radiographic outcomes between CWO and OWO in any study. The risks of dural tear, neurological injury, and reoperation were similar between groups. Blood loss was greater in the closing wedge compared with the opening wedge group, while the risk of paralytic ileus was less. The overall strength of evidence for the conclusions is low.

[1]  B. Qian,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 , 2012, Journal of spinal disorders & techniques.

[2]  R. Arun,et al.  Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction , 2011, European Spine Journal.

[3]  P. Tak,et al.  Advances in rheumatology: new targeted therapeutics , 2011, Arthritis research & therapy.

[4]  T. Burd,et al.  Corrective osteotomies in spine surgery. , 2008, The Journal of bone and joint surgery. American volume.

[5]  Ying-Yu Chen,et al.  Closing Wedge Osteotomy Versus Opening Wedge Osteotomy in Ankylosing Spondylitis With Thoracolumbar Kyphotic Deformity , 2005, Spine.

[6]  Erik N. Kubiak,et al.  Orthopaedic Management of Ankylosing Spondylitis , 2005, The Journal of the American Academy of Orthopaedic Surgeons.

[7]  N. Arafati,et al.  Surgery of the deformities in ankylosing spondylitis: Our experience of lumbar osteotomies in 31 patients , 2005, European Spine Journal.

[8]  G. Guyatt,et al.  Grading quality of evidence and strength of recommendations , 2004, BMJ : British Medical Journal.

[9]  Jan Brandt,et al.  Biologic therapies in the spondyloarthritis: new opportunities, new challenges , 2003, Current opinion in rheumatology.

[10]  Marc F Swiontkowski,et al.  Introducing levels of evidence to the journal , 2011, The Journal of bone and joint surgery. American volume.

[11]  N McKoy,et al.  Systems to rate the strength of scientific evidence. , 2002, Evidence report/technology assessment.

[12]  V. Deviren,et al.  Management of Fixed Sagittal Plane Deformity: Results of the Transpedicular Wedge Resection Osteotomy , 2001, Spine.

[13]  Tzai-Chiu Yu,et al.  Transpedicular Wedge Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Experience With 78 Patients , 2001, Spine.

[14]  A. Gast,et al.  Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment , 1999 .

[15]  B. V. van Royen,et al.  Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment , 1999, Annals of the rheumatic diseases.

[16]  B. V. van Royen,et al.  Polysegmental lumbar posterior wedge osteotomies for correction of kyphosis in ankylosing spondylitis , 1998, European Spine Journal.

[17]  A. Weale,et al.  Secure fixation of lumbar osteotomy. Surgical experience with 50 patients. , 1995, Clinical orthopaedics and related research.

[18]  B. V. van Royen,et al.  Closing-wedge posterior osteotomy for ankylosing spondylitis. Partial corporectomy and transpedicular fixation in 22 cases. , 1995, The Journal of bone and joint surgery. British volume.

[19]  D. Jaffray,et al.  Closing wedge osteotomy with transpedicular fixation in ankylosing spondylitis. , 1992, Clinical orthopaedics and related research.

[20]  K. Zielke,et al.  Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis. Report on 177 cases. , 1990, Clinical orthopaedics and related research.

[21]  C. Pq Correction of kyphotic deformity in ankylosing spondylitis using multiple spinal osteotomy and Zielke's VDS instruments. , 1988 .

[22]  R. Winter,et al.  Ankylosing Spondylitis: Experience in Surgical Management of 21 Patients , 1987, Spine.

[23]  E. Thomasen Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. , 1985, Clinical orthopaedics and related research.

[24]  M. Mcmaster A technique for lumbar spinal osteotomy in ankylosing spondylitis. , 1985, The Journal of bone and joint surgery. British volume.

[25]  E. Simmons Kyphotic Deformity of the Spine in Ankylosing Spondylitis , 1977, Clinical orthopaedics and related research.

[26]  Coventry Mb,et al.  Spinal osteotomy in akylosing spondylitis. Technique, complications, and long-term results. , 1973 .

[27]  Bossers Gt Columnotomy in severe Bechterew kyphosis. , 1972 .

[28]  G. T. Bossers Columnotomy in severe Bechterew kyphosis. , 1972, Acta orthopaedica Belgica.

[29]  C. Larson,et al.  Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. , 1969, Clinical orthopaedics and related research.

[30]  M. Goel Vertebral osteotomy for correction of fixed flexion deformity of the spine. , 1968, The Journal of bone and joint surgery. American volume.

[31]  H. Emnéus Wedge osteotomy of spine in ankylosing spondylitis. , 1968, Acta orthopaedica Scandinavica.

[32]  J. Calabro,et al.  VERTEBRAL WEDGE OSTEOTOMY. CORRECTION OF RHEUMATOID (ANKYLOSING) SPONDYLITIS. , 1963, JAMA.

[33]  J. Adams Technique, dangers and safeguards in osteotomy of the spine. , 1952, The Journal of bone and joint surgery. British volume.