Objective: Ankylosing spondylitis is a systemic disease which affects the axial skeleton and may cause rigid spinal deformities in advanced cases. Clinical and radiological results of patients with ankylosing spondylitis who underwent pedicle subtraction osteotomy (PSO) were evaluated.Methods: Twelve (3 female, 9 male) patients who were treated for rigid spinal deformities due to ankylosing spondylitis were evaluated. All patients were treated with the same surgical technique, which included PSO and pedicle screw-rod combination. For radiological results, thoracic kyphosis, lumbar lordosis, pelvic parameters (pelvic incidence, sacral inclination, pelvic tilt), and the distance between the central sagittal line (CSVL) and the sacrum were measured from pre- and postoperative radiograms. For functional results, SF-36 and Oswestry Disability Index (ODI) were used.Results: Mean age of the patients was 39.8±8.4 years, and mean follow-up was 85.6±39.1 months. Mean angle of lordosis was improved from 6.6°±13.7° preoperatively to 43.8°±8.4° postoperatively (p<0.0001). Mean CSVL was improved from 19.7±9.7 cm preoperatively to 7.45±3.8 cm postoperatively (p=0.0005). Mean local angular change around the osteotomy site was 30.2°±6.2°. The pelvic parameters were not significantly changed after the surgeries. Mean ODI, SF-36 mental, and SF-36 physical scores were 30.16±9.7, 41.2±9.9 and 35.3±7.1, respectively.Conclusion: In patients with rigid sagittal spinal deformities due to ankylosing spondylitis, lumbar lordosis and sagittal balance can be obtained using PSO.
Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 1998;41:58-67.
van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27:361-8.
Dean LE, Jones GT, MacDonald AG, Downham C, Stur- rock RD, Macfarlane GJ. Global prevalence of ankylosing spondylitis. Rheumatology (Oxford) 2014;53:650-7.
Kubiak EN, Moskovich R, Errico TJ, Di Cesare PE. Or- thopaedic management of ankylosing spondylitis. J Am Acad Orthop Surg 2005;13:267-78.
Park YS, Kim HS, Baek SW. Spinal osteotomy in anky- losing spondylitis: radiological, clinical, and psychological results. Spine J 2014;14:1921-7.
Berven SH, Deviren V, Smith JA, Emami A, Hu SS, Brad- ford DS. Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine (Phila Pa 1976) 2001;26:2036-43.
Goel MK. Vertebral osteotomy for correction of fixed flexion deformity of the spine. J Bone Joint Surg Am 1968;50:287-94.
Jaffray D, Becker V, Eisenstein S. Closing wedge osteotomy with transpedicular fixation in ankylosing spondylitis. Clin Orthop Relat Res 1992;279:122-6.
Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheuma- toid arthritis. Clin Orthop Relat Res 1969;66:6-9.
Van Royen BJ, De Gast A. Lumbar osteotomy for correc- tion of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treat- ment. Ann Rheum Dis 1999;58:399-406.
Weatherley C, Jaffray D, Terry A. Vascular complications associated with osteotomy in ankylosing spondylitis: a re- port of two cases. Spine (Phila Pa 1976) 1988;13:43-6.
ADAMS JC. Technique, dangers and safeguards in osteot- omy of the spine. J Bone Joint Surg Br 1952;34-B:226-32.
Camargo FP, Cordeiro EN, Napoli MM. Corrective oste- otomy of the spine in ankylosing spondylitis. Experience with 66 cases. Clin Orthop Relat Res 1986;208:157-67.
Arun R, Dabke HV, Mehdian H. Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instru- mented reduction. Eur Spine J 2011;20:2252-60.
Cho KJ, Bridwell KH, Lenke LG, Berra A, Baldus C. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976) 2005;30:2030-8.
Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathol- ogy. Eur Spine J 2011;20 Suppl 5:609-18.
McMaster MJ. A technique for lumbar spinal osteotomy in ankylosing spondylitis. J Bone Joint Surg Br 1985;67:204- 10.
Brox JI, Helle A, Sİrensen R, Gunderson R, Riise R, Reikerås O. Functional outcome after lumbar closing wedge osteotomy in ankylosing spondylitis. Int Orthop 2009;33:1049-53.
Kiaer T, Gehrchen M. Transpedicular closed wedge os- teotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis. Eur Spine J 2010;19:57-64.
Lazennec JY, Saillant G, Saidi K, Arafati N, Barabas D, Benazet JP, et al. Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients. Eur Spine J 1997;6:222-32.
Bridwell KH, Lewis SJ, Edwards C, Lenke LG, Iffrig TM, Berra A, et al. Complications and outcomes of pedicle sub- traction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976) 2003;28:2093-101.
Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC Jr, Dijkmans B, et al. ASAS/EULAR recom- mendations for the management of ankylosing spondylitis. Ann Rheum Dis 2006;65:442-52.
Ravinsky RA, Ouellet JA, Brodt ED, Dettori JR. Verte- bral Osteotomies in Ankylosing Spondylitis-Comparison of Outcomes Following Closing Wedge Osteotomy versus Opening Wedge Osteotomy: A Systematic Review. Evid Based Spine Care J 2013;4:18-29.
Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis be- fore and after pedicle subtraction osteotomy. Eur Spine J 2010;19:65-70.
Kim YJ, Bridwell KH, Lenke LG, Cheh G, Baldus C. Re- sults of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976) 2007;32:2189-97.
Chang KW, Chen YY, Lin CC, Hsu HL, Pai KC. Clos- ing wedge osteotomy versus opening wedge osteotomy in ankylosing spondylitis with thoracolumbar kyphotic defor- mity. Spine (Phila Pa 1976) 2005;30:1584-93.