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- Title
The Influence Of Postoperative Apical Vertebra Location On Clinical Outcomes In Ankylosing Spondylitis Patients With Thoracolumbar Kyphosis.
- Authors
Bangping Qian; Zhuojie Liu; Yong Qiu
- Abstract
Introduction: Relocation of apical vertebra after surgery is widely found in AS patients. However, the influence of postoperative location of apical vertebra on sagittal balance and clinical outcomes in AS patients has not been investigated yet. This study aims to evaluate the influence of postoperative location of apical vertebra on clinical outcomes in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis (AS). Materials and methods: Sixty-four patients (60 males and 4 females), with a mean age of 34.28+ 9.60 years (range, 17-59 years)and a mean follow-up of 35.56 + 16.07 months (range, 24-98 months) were divided into 2 groups according to the postoperative location of apical vertebra (Group 1, T8 or above; Group 2, T9 or below). The radiographical measurements, including global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI) and 3 apexrelated parameters (horizontal distance between C7 and apex, DCA; horizontal distance from sacrum to apex, DSA and horizontal distance measured between osteotomized vertebra and apex, DOA), along with clinical outcomes measured by health related quality of life (HRQOL) questionnaire were compared between the 2 groups postoperatively and at the last follow-up. Furthermore, a subgroup analysis of patients with apex located on T6-T11 was performed and 62 normal controls were enrolled for comparison between the whole AS cohort and healthy individuals regarding apical vertebra location of the thoracic spine. Results: The majority of apical vertebra location changed from T12-L2 preoperatively to T6-T9 postoperatively. SVA differed significantly both postoperatively (25.70mm vs. 59.07mm, P < 0.001) and at the last follow-up (32.92mm vs. 61.30mm, P = 0.003) between the 2 groups and patients form Group 1 had significantly smaller DCA than patients in Group 2 (69.03mm vs. 103.11 mm, P < 0.001). Subgroup analysis demonstrated similar results, showing that patients with apex located at T8 or above had an average SVA<47mm. There was a significant correlation between postoperative SVA and DCA. However, no significant difference was found in HRQOL between the 2 groups. Conclusion: AS patients with apex located at T8 or above after surgery tended to have better SVA correction (within 47mm) than those who had a more caudally located apical vertebra, but apical vertebra location did not affect these patients' HRQOL scores.
- Publication
Global Spine Journal, 2018, Vol 8, p221S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771072