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- Title
Does Preoperative Distal-Apex Alignment Affect the Selection of Osteotomy Segment in Pedicle Subtraction Osteotomy for Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis?
- Authors
Weiyi Diao; Bangping Qian; Yong Qiu
- Abstract
Introduction: To investigate the correlations between preoperative sagittal distal-apex alignment and the selection of osteotomy level in one-level pedicle subtraction osteotomy (PSO) for correction of thoracolumbar kyphosis secondary to ankylosing spondylitis (AS). Materials and Methods: A retrospective study of consecutive AS patients with thoracolumbar kyphosis underwent one-level PSO was performed. Patients with lordotic distal-apex alignment were assigned to group A, while others with kyphotic distal-apex alignment were assigned to group B. The preoperative and postoperative radiologic parameters included global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacrum slope (SS) were measured and compared. Correction efficient of PSO at different levels was compared. Perioperative and long-term complications were reviewed. Results: Patients in group A and group B had the mean age of 35.9 and 35.0 years, respectively. The thoracolumbar kyphosis was corrected from a mean preoperative GK of 67.8° to 35.9° in group A and from 72.0° to 38.3° in group B, and LL was corrected from -21.0° to -54.0° and from 2.3° to -43.3°, respectively. No obvious loss of GK correction (3.2°/3.9°) was observed in both groups at the final follow-up. Statistically significant differences were found for preoperative and correction of LL and SVA between group A and B. The correction of LL and SVA showed a strong increasing tendency as the PSO level went down from L1 to L3. Conclusions: Satisfactory correction of LL, SVA and SS was achieved in both groups, with no obvious loss of correction at the latest follow-up. For patients with lordotic distal-apex alignment, PSO at L1 or L2 is appropriate. As the preoperative LL still remains, great correction of LL is unnecessary. PSO at L2 or L3 is recommended for patients with kyphotic distal-apex alignment, as lower lumbar vertebra could provide more correction of LL and SVA.
- Publication
Global Spine Journal, 2018, Vol 8, p161S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771030