Clinical Outcome and Complications of Transpedicular Closing-wedge Osteotomy for Correction of Deformity in Ankylosing Spondylitis in a Regional Hospital

Study designProspective study of surgical correction of thoracolumbar kyphotic deformity caused by ankylosing spondylitis.ObjectivesTo assess surgical outcomes and complications of thoracolumbar kyphotic deformity corrected with transpedicular closing-wedge osteotomy performed in a regional hospital.Summary of background dataThere have been several studies reporting on the results of surgical correction of deformity in ankylosing spondylitis all over the world. However, there has not been any local data published.MethodsFrom 2003 to 2011, we had performed 12 transpedicular closing-wedge osteotomies in 9 patients with ankylosing spondylitis for correction of kyphotic and scoliotic deformity in thoracolumbar spine. Operative outcomes were assessed clinically by recording the Japanese Orthopaedic Association (JOA) scores, visual analogue scale (VAS) pain scores, Oswestry Disability Index (ODI) preoperatively and postoperatively and patient satisfaction postoperatively. Radiological outcome was assessed by measuring thoracic kyphosis, lumbar lordosis and sagittal plumb line preoperatively and postoperatively as well as the degree of surgical correction. Occurrence of complications was recorded by our standard audit protocol.ResultsAll patients had a single level of osteotomy done at a time. Most of the osteotomies were done at L2 or L3. The mean amount of correction was 21.6°. Complications included dural tear, pseudoarthrosis and transient radiculopathy. The extent of correction and incidence of complications improved with experience.ConclusionDespite transpedicular closing-wedge osteotomy being a major operation that is not without complications, most of our patients had good clinical results and subjective satisfaction.

中 文 摘 要研究設計引起強直性脊柱炎胸腰椎後凸畸形矯正手術的前瞻性研究。, 背景: 在世界各地已經有一些關於矯正強直性脊柱炎引致胸腰椎畸形的手術結果報告。然而，到目前為止並無任何本地公佈的數據。因此本硏究將會評估本醫院進行椎弓根閉合式截骨矯正術矯正強直性脊柱炎駝背畸形的手術結果和並發症。方法從2003年到2011年，我們已為九位強直性脊柱炎病人進行了十二次椎弓根閉合式截骨矯正手術 。並為病人進行術前和術後的臨床評估。記錄日本骨科協會（JOA）腰椎評分，視覺模擬評分法（VAS）疼痛評分，功能障礙指數（ODI）， 和術後病人的滿意度。同時亦以X光照片測量胸椎後凸，腰椎前凸幅度，矢狀鉛垂線以及術前和術後的手術矯正幅度。結果所有患者於同一時間只進行一節截骨 。大多數的截骨均在腰椎第二，三節進行 。 平均矯正幅度為21.6度。並發症包括硬膜撕裂，假關節和短暫神經受損。結論儘管椎弓根閉合楔形截骨術是一項重大手術，並有不少並發症。但大多數患者均有良好的臨床效果和主觀滿意度