title: Posterior wedge osteotomy and debridement for Andersson lesion with severe kyphosis in ankylosing spondylitis.
abstract: BACKGROUND
  Andersson lesion is a well-known complication in ankylosing spondylitis. Recently, owing to the worry about the healing of fracture, some scholars advocated additional anterior surgery or other procedures were necessary, which increase the risk of the nerve injury. The purpose of this study is to introduce our experience and to explore the efficacy and feasibility of posterior wedge osteotomy and debridement through Andersson Lesion for surgical treatment of severe kyphosis in ankylosing spondylitis.
  
  
  METHODS
  From January 2012 to January 2014, a retrospective study of 14 Andersson lesion patients with severe kyphosis in ankylosing spondylitis treated with surgery was completed with an at least 2-year follow-up. The debridement procedure, before posterior wedge osteotomy in posterior approach, must scrape all sclerosis bone until healthy cancellous bone appears. Radiographic and clinical results and complications were assessed with an average follow-up of 24 months. The CT scan was obtained preoperatively and at the final follow-up to assess the displacement of the fracture preoperatively, the safety of screw insertion, the healing of the fracture at the final follow-up. The Bridwell interbody fusion grading system was used to assess the healing of the fracture.
  
  
  RESULTS
  Local kyphosis was substantially corrected from 51.7 ± 15.6 to 7.1 ± 19.5, with a mean correction of 44°. The global kyphosis (GK) changed from 60.6 ± 28.3 to 20.3 ± 10.3 (P = 0.000). The mean VAS back pain scores decreased from 6.7 ± 0.8 preoperatively to 0.75 ± 0.6 after a 2-year follow-up (P = 0.000). The ODI score improved from 60.56 ± 15.1% preoperatively to 23.46 ± 8.2% after a 2-year follow-up (P = 0.000). The CT scan showed solid fusion at the level of the AL, and no internal fixation loose. All patients achieved grade 1 fusion. No major complication occurred.
  
  
  CONCLUSIONS
  The posterior wedge osteotomy and debridement through AL can be used to correct the severe kyphosis in ankylosing spondylitis, achieving favorable clinical outcomes, good fusion, and satisfactory deformity correction.
authors.affiliation: Orthopedic Department, The General Hospital of Chinese People's Liberation Army (301 hospital) Beijing, No.28.Fu Xing Rd, Hai Dian District, 100853, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Orthopedic Department, The General Hospital of Chinese People's Liberation Army (301 hospital) Beijing, No.28.Fu Xing Rd, Hai Dian District, 100853, Beijing, China.
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Tang
authors.affiliation: Orthopedic Department, The General Hospital of Chinese People's Liberation Army (301 hospital) Beijing, No.28.Fu Xing Rd, Hai Dian District, 100853, Beijing, China.
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Orthopedic Department, The General Hospital of Chinese People's Liberation Army (301 hospital) Beijing, No.28.Fu Xing Rd, Hai Dian District, 100853, Beijing, China. orth_wangzheng301@163.com.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000328:Adult; D003646:Debridement / Q000379:methods; D015299:Discitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Andersson lesion; Ankylosing spondylitis; Osteotomy; Oswestry Disability Index; Visual analog scale