Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis. Report on 177 cases.
Despite conservative therapy in ankylosing spondylitis, kyphotic deformities are common. Mono-segmental lumbar osteotomy had a high complication rate. Therefore, a poly-segmental lordosis osteotomy of the lumbar spine was introduced in four to six segments using trans-pedicled screws and threaded rods in eight to ten segments (isolated correction is possible for each segment). Instead of dangerous short kinking, a poly-segmental lordosis osteotomy results in harmonious lordosis with a correction per segment of about 10 degrees, and complications are decreased. Of 177 patients undergoing the operation, there was a 2.3% mortality rate with cardiopulmonary problems, 2.3% with irreversible complications, and 18.1% with reversible complications, mostly small root lesions, of which 7% were reoperated. The 173 surviving patients had a correction of 43%, and improvement in body height of 9 cm, and improvement of flexion by 57%. Fifty-three patients have been followed for more tha 18 months. the visual axis in all cases was horizontal. No pseudoarthrosis occurred. After correction, the frequent spondylodiscitis healed. Ninety-two percent were pain free compared with 15% before the operation. Loss of correction of body height was 20%, of flexion 4%, and of the lordosis 7%, which was 18% in 37 patients after three years.
Hehne
H J
HJ
Department of Surgery, University of Freiburg, Federal Republic of Germany.
Zielke
K
K
Böhm
H
H
D000328:Adult; D000368:Aged; D001416:Back Pain / Q000601:surgery; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation; D013167:Spondylitis, Ankylosing / Q000601:surgery*