| BackgroundAnkylosing spondylitis (AS) is one kind of the spondyloarthritis, generallycausing the rigid spinal deformity. The typical deformities include increased thoracic kyphosis, increased thoracolumbar kyphosis, decreased or even backwards-arched lumbar lordosis, and hip joints were involved in some patients. Spinal is the only way to realign the sagittal spine, improve the figure and looking horizontally. Previous studies focused on the spinal realignment rather than the comprehensive corrective resolution in AS patients with cervical spine and hip joint involvement. And no reports described the selection of instrumented segments in such cases.Objective 1. To present and assess a comprehensive resolution for the management of thoracolumbar kyphosis caused by AS, accompanied with cervical spine and hip joint involvement.2. To determine the optimal selection of upper instrumented vertebra (UIV) and lowest instrumented vertebra (LIV) in AS thoracolumbar kyphosis.Material and Methods 1. From January 2013 to January 2014,12 consecutive AS patients with cervical spine and hip joint involved were treated by the comprehensive resolution. The pre- and post-operative radiographic parameters, SRS-22 score, Oswestry disability index (ODI) and Harris functional score of hip joint were compared.2.From January 2010 to May2013,123 AS thoracolumbar kyphosis cases treated with pedicle subtraction osteotomy (PSO) were retrospectively reviewed. According to the relationship between UIV and proximal osteotomied vertebra (OV), all cases were divided into Group A:UIV was the third vertebra cranial to the proximal OV, and Group B:UIV was the forth vertebra or more cranial to the proximal OV. The two groups were compared for preoperative and 24-month postoperative radiographic parameters and clinical data. What’s more, all the included patients were divided into groups based on the relative position of LIV and distal OV:Group OV+2-the LIV was the second vertebra below OV; Group OV+3-the LIV was the third vertebra below OV. These two groups were compared for preoperative and 24-month postoperative radiographic parameters and clinical data. In addition, according to whether LIV was S1, all patients were divided into two groups:Group S1 and Group Non-S1 (the LIV was L5 or above), the above-mentioned parameters and data were compared again.Results 1.24 months after operation, besides pelvic incidence, all of the sagittal parameters, SRS-22 score, ODI and Harris functional score were improved significantly in the 12 cases.2. During the 29.3 (24-60) months follow-up, no fixation failure occurred in all patients. Group A and Group B had no significant differences in age and gender composition (P>0.05). The mean instrumented segments of Group A were less than that in Group B (P<0.05). Two groups had similar magnitudes of deformity corrections (P>0.05) and functional improvement (P>0.05) at the 24-month follow-up. The incidence of complaining about the protrudent sensation in Group A is higher than that in Group B (P<0.05). Group OV+2 and Group OV+3 had similar magnitudes of deformity corrections (P>0.05) and functional improvement (P>0.05) at the last follow-up. The lumbosacral VAS and the incidence of pressure sores in Group S1 were higher than that in Group Non-S1 (P<0.05).Conclusion 1.By the comprehensive resolution, AS kyphosis patients with cervical spine and hip joint involvedcloud getsatisfying sagittal realignment, appearance improvement and sitting-standing-lying flat function.2.When PSO is performed to treat the AS thoracolumbar kyphosis,3 vertebra cranially to the proximal OV is enough for the correction and fixation with low incidence of complaining about the protrudent sensation. When PSO is performed at the L2 or L3 level the instrumentation can be limited to the 2 caudally following vertebrae. Extending the fixation to more vertebrae or to the sacrum seems not to improve the solidity of the instrumentation and the fusion rate. |
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