The Influence of Closing-Opening Wedge Osteotomy on Sagittal Balance in Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis: A Comparison With Closing Wedge Osteotomy

Study Design. A retrospective study. Objective. To compare the radiographical and clinical outcomes between closing wedge osteotomy (CWO) and closing-opening wedge osteotomy (COWO) for thoracolumbar kyphosis secondary to ankylosing spondylitis. Summary of Background Data. Several surgical techniques have been used to correct the fixed thoracolumbar kyphosis caused by ankylosing spondylitis. To date, the comparison of the outcomes between CWO and COWO has not yet been addressed. Methods. According to the association with anterior edge opening or not shown on the postoperative radiographs, 64 patients were divided into 2 groups (35 patients in the CWO group and 29 patients in the COWO group). The radiographical and clinical outcomes were compared between the 2 groups, with a mean follow-up of 36 months (range, 24–84 mo). Radiographical measurements included thoracic kyphosis, lumbar lordosis, global kyphosis, sagittal vertical axis, osteotomized vertebra angle, and the height of the osteotomized vertebra. Oswestry Disability Index was evaluated at the final follow-up. Results. Thoracic kyphosis did not change significantly between postoperatively and the final follow-up in both groups. The mean corrections of lumbar lordosis, global kyphosis, sagittal vertical axis, and osteotomized vertebra angle were significantly larger in the COWO group than in the CWO group (P < 0.05). Notably, statistically significant differences (P < 0.05) were observed in the variation of height of the osteotomized vertebra (1.3 cm in the CWO group vs. 0.7 cm in the COWO group). In both groups, no patients had pseudarthrosis at the osteotomy level at the last follow-up. There was no significant difference of Oswestry Disability Index scores between the 2 groups at the final follow-up. Conclusion. Both CWO and COWO are safe and effective surgical methods for correction of thoracolumbar kyphosis. COWO can obtain larger correction and better sagittal alignment without additional neurological complications.

[1]  Xiangyang Leng,et al.  Quality Control of Reconstructed Sagittal Balance for Sagittal Imbalance , 2011, Spine.

[2]  G. Demey,et al.  Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy , 2009, European Spine Journal.

[3]  T. Kiaer,et al.  Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis , 2009, European Spine Journal.

[4]  O. Reikerås,et al.  Functional outcome after lumbar closing wedge osteotomy in ankylosing spondylitis , 2009, International Orthopaedics.

[5]  Hung-Chang Chen,et al.  Closing-Opening Wedge Osteotomy for the Treatment of Sagittal Imbalance , 2008, Spine.

[6]  M. Mullender,et al.  Effectiveness of preoperative planning in the restoration of balance and view in ankylosing spondylitis. , 2008, Neurosurgical focus.

[7]  Yang-Jin Im,et al.  Spinal Pseudarthrosis in Advanced Ankylosing Spondylitis With Sagittal Plane Deformity: Clinical Characteristics and Outcome Analysis , 2007, Spine.

[8]  K. Bridwell.  Decision Making Regarding Smith-Petersen vs. Pedicle Subtraction Osteotomy vs. Vertebral Column Resection for Spinal Deformity , 2006, Spine.

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

[10]  B. Dijkmans,et al.  Susceptibility to ankylosing spondylitis: no evidence for the involvement of transforming growth factor β1 (TGFB1) gene polymorphisms , 2005, Annals of the rheumatic diseases.

[11]  P. Anderson,et al.  Spinal Osteotomy in Patients With Ankylosing Spondylitis: Complications During First Postoperative Year , 2005, Spine.

[12]  S. van der Linden,et al.  Clinical vertebral fractures in patients with ankylosing spondylitis. , 2004, The Journal of rheumatology.

[13]  J. Bring,et al.  Spinal fractures in patients with ankylosing spondylitis , 1996, European Spine Journal.

[14]  K. Suk,et al.  Clinical Outcome Results of Pedicle Subtraction Osteotomy in Ankylosing Spondylitis With Kyphotic Deformity , 2002, Spine.

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

[16]  H. Baba,et al.  Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. , 2001, Spine.

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

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

[19]  M. Harris,et al.  Wedge osteotomy for the correction of post-traumatic kyphosis. A new technique and a report of three cases. , 1992, Spine.

[20]  D. Jaffray,et al.  Vascular Complications Associated with Osteotomy in Ankylosing Spondylitis: A Report of Two Cases , 1988, Spine.

[21]  J C Fairbank,et al.  The Oswestry low back pain disability questionnaire. , 1980, Physiotherapy.

[22]  P. D. Wilson,et al.  Possible mechanism of aortic rupture in orthopaedic correction of rheumatoid spondylitis. , 1956, The Journal of bone and joint surgery. American volume.