A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy

Yongchun Xiao; Gengxiong Lin; Guowei Zhang; Hua Yang; Zhisheng Ji; Hongsheng Lin

doi:doi:10.11648/j.js.20221003.18

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A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy

Yongchun Xiao, Gengxiong Lin, Guowei Zhang, Hua Yang, Zhisheng Ji, Hongsheng Lin

Published in Journal of Surgery (Volume 10, Issue 3)

Received: 1 June 2022 Accepted: 22 June 2022 Published: 30 June 2022

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Abstract

Ankylosing spondylitis is a disease characterized by inflammation of sacroiliac joint and spinal attachment point. It is strongly associated with HLA-B27. About 30% of patients will develope kyphosis. It not only causes severe kyphosis, restricted mobility, ugly appearance, and human head-up disorder, but also severe kyphosis causes sleep difficulties, compression of the chest and abdominal organs, and abdominal muscles. Contractures lead to disorders of the digestive function of the gastrointestinal tract and superior mesenteric artery syndrome, and even more serious psychological disorders, and even loss of confidence in life. The most effective treatment for ankylosing spondylitis kyphosis is spinal orthopedics. We report a 38-year-old male patient who was hospitalized with ankylosing spondylitis and kyphosis due to low back pain and activity limitation for 20 years, and progressive aggravation of his kyphosis for 10 years. The measurement of preoperative imaging parameters indicated: Pelvic Incidence (PI) = 61°, Pelvic Tilt (PT) = 64°, Sacral Slope (SS) = -3°, Lumbar Lordosis (LL) = -25°, Thoracolumbar Junction (TLJ) = 45°, Thoracic Kyphosis (TK) = 65°, Chin-Brow Vertical Angle (CBVB) = 60°. With adequate preoperative planning and discussion, we performed a two-level pedicle subtraction osteotomy, which requires comprehensive perioperative care and more refined intraoperative manipulation. The postoperative patient was 169cm, the height increased by 32cm, postoperative parameter measurement, PI = 60°, PT = 38°, SS = 22°, LL = 52°, TLJ = 15°, TK = 19°, CBVB = 13°. After the operation, the patient recovered well, the treatment effect was satisfactory, and the quality of life was significantly improved. Two-level pedicle subtraction osteotomy is a high-risk and high-demand operation that needs to be performed by an experienced spinal surgery team.

Published in	Journal of Surgery (Volume 10, Issue 3)
DOI	10.11648/j.js.20221003.18
Page(s)	131-135
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Ankylosing Spondylitis, Spondyloarthritis, Kyphosis, Pedicle Subtraction Osteotomy, Case Report

References

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[3]	Koller, H., et al., Osteotomies in ankylosing spondylitis: where, how many, and how much? Eur Spine J, 2018. 27 (Suppl 1): p. 70-100.
[4]	Hu, F., et al., Improvement of Sleep Quality in Patients With Ankylosing Spondylitis Kyphosis After Corrective Surgery. Spine (Phila Pa 1976), 2020. 45 (23): p. E1596-e1603.
[5]	Park, J. S., et al., Psychological Changes and Employment Outcomes After Kyphosis Correction in Patients With Ankylosing Spondylitis. Spine (Phila Pa 1976), 2019. 44 (14): p. 996-1002.
[6]	Liu, C., et al., Changes of the abdomen in patients with ankylosing spondylitis kyphosis. Spine (Phila Pa 1976), 2015. 40 (1): p. E43-8.
[7]	Fu, J., et al., Pulmonary function improvement in patients with ankylosing spondylitis kyphosis after pedicle subtraction osteotomy. Spine (Phila Pa 1976), 2014. 39 (18): p. E1116-22.
[8]	Cho, K. J., et al., Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005. 30 (18): p. 2030-7; discussion 2038.
[9]	Burton, D. C., Smith-Petersen osteotomy of the spine. Instr Course Lect, 2006. 55: p. 577-82.
[10]	Gupta, M. C., et al., Pedicle Subtraction Osteotomy. JBJS Essent Surg Tech, 2020. 10 (1).
[11]	Kim, K. T., et al., Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine (Phila Pa 1976), 2002. 27 (6): p. 612-8.
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[15]	Xin, Z., et al., Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients. J Orthop Surg Res, 2019. 14 (1): p. 330.
[16]	Zheng, G. Q., et al., Two-level spinal osteotomy for severe thoracolumbar kyphosis in ankylosing spondylitis. Experience with 48 patients. Spine (Phila Pa 1976), 2014. 39 (13): p. 1055-8.
[17]	Kawahara, N., et al., Influence of acute shortening on the spinal cord: an experimental study. Spine (Phila Pa 1976), 2005. 30 (6): p. 613-20.
[18]	Bridwell, K. H., et al., Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976), 2003. 28 (18): p. 2093-101.
[19]	Hyun, S. J. and S. C. Rhim, Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data. J Korean Neurosurg Soc, 2010. 47 (2): p. 95-101.
[20]	Buchowski, J. M., et al., Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976), 2007. 32 (20): p. 2245-52.
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APA Style

Yongchun Xiao, Gengxiong Lin, Guowei Zhang, Hua Yang, Zhisheng Ji, et al. (2022). A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy. Journal of Surgery, 10(3), 131-135. https://doi.org/10.11648/j.js.20221003.18

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ACS Style

Yongchun Xiao; Gengxiong Lin; Guowei Zhang; Hua Yang; Zhisheng Ji, et al. A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy. J. Surg. 2022, 10(3), 131-135. doi: 10.11648/j.js.20221003.18

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AMA Style

Yongchun Xiao, Gengxiong Lin, Guowei Zhang, Hua Yang, Zhisheng Ji, et al. A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy. J Surg. 2022;10(3):131-135. doi: 10.11648/j.js.20221003.18

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@article{10.11648/j.js.20221003.18,
  author = {Yongchun Xiao and Gengxiong Lin and Guowei Zhang and Hua Yang and Zhisheng Ji and Hongsheng Lin},
  title = {A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy},
  journal = {Journal of Surgery},
  volume = {10},
  number = {3},
  pages = {131-135},
  doi = {10.11648/j.js.20221003.18},
  url = {https://doi.org/10.11648/j.js.20221003.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20221003.18},
  abstract = {Ankylosing spondylitis is a disease characterized by inflammation of sacroiliac joint and spinal attachment point. It is strongly associated with HLA-B27. About 30% of patients will develope kyphosis. It not only causes severe kyphosis, restricted mobility, ugly appearance, and human head-up disorder, but also severe kyphosis causes sleep difficulties, compression of the chest and abdominal organs, and abdominal muscles. Contractures lead to disorders of the digestive function of the gastrointestinal tract and superior mesenteric artery syndrome, and even more serious psychological disorders, and even loss of confidence in life. The most effective treatment for ankylosing spondylitis kyphosis is spinal orthopedics. We report a 38-year-old male patient who was hospitalized with ankylosing spondylitis and kyphosis due to low back pain and activity limitation for 20 years, and progressive aggravation of his kyphosis for 10 years. The measurement of preoperative imaging parameters indicated: Pelvic Incidence (PI) = 61°, Pelvic Tilt (PT) = 64°, Sacral Slope (SS) = -3°, Lumbar Lordosis (LL) = -25°, Thoracolumbar Junction (TLJ) = 45°, Thoracic Kyphosis (TK) = 65°, Chin-Brow Vertical Angle (CBVB) = 60°. With adequate preoperative planning and discussion, we performed a two-level pedicle subtraction osteotomy, which requires comprehensive perioperative care and more refined intraoperative manipulation. The postoperative patient was 169cm, the height increased by 32cm, postoperative parameter measurement, PI = 60°, PT = 38°, SS = 22°, LL = 52°, TLJ = 15°, TK = 19°, CBVB = 13°. After the operation, the patient recovered well, the treatment effect was satisfactory, and the quality of life was significantly improved. Two-level pedicle subtraction osteotomy is a high-risk and high-demand operation that needs to be performed by an experienced spinal surgery team.},
 year = {2022}
}

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TY  - JOUR
T1  - A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy
AU  - Yongchun Xiao
AU  - Gengxiong Lin
AU  - Guowei Zhang
AU  - Hua Yang
AU  - Zhisheng Ji
AU  - Hongsheng Lin
Y1  - 2022/06/30
PY  - 2022
N1  - https://doi.org/10.11648/j.js.20221003.18
DO  - 10.11648/j.js.20221003.18
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 131
EP  - 135
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20221003.18
AB  - Ankylosing spondylitis is a disease characterized by inflammation of sacroiliac joint and spinal attachment point. It is strongly associated with HLA-B27. About 30% of patients will develope kyphosis. It not only causes severe kyphosis, restricted mobility, ugly appearance, and human head-up disorder, but also severe kyphosis causes sleep difficulties, compression of the chest and abdominal organs, and abdominal muscles. Contractures lead to disorders of the digestive function of the gastrointestinal tract and superior mesenteric artery syndrome, and even more serious psychological disorders, and even loss of confidence in life. The most effective treatment for ankylosing spondylitis kyphosis is spinal orthopedics. We report a 38-year-old male patient who was hospitalized with ankylosing spondylitis and kyphosis due to low back pain and activity limitation for 20 years, and progressive aggravation of his kyphosis for 10 years. The measurement of preoperative imaging parameters indicated: Pelvic Incidence (PI) = 61°, Pelvic Tilt (PT) = 64°, Sacral Slope (SS) = -3°, Lumbar Lordosis (LL) = -25°, Thoracolumbar Junction (TLJ) = 45°, Thoracic Kyphosis (TK) = 65°, Chin-Brow Vertical Angle (CBVB) = 60°. With adequate preoperative planning and discussion, we performed a two-level pedicle subtraction osteotomy, which requires comprehensive perioperative care and more refined intraoperative manipulation. The postoperative patient was 169cm, the height increased by 32cm, postoperative parameter measurement, PI = 60°, PT = 38°, SS = 22°, LL = 52°, TLJ = 15°, TK = 19°, CBVB = 13°. After the operation, the patient recovered well, the treatment effect was satisfactory, and the quality of life was significantly improved. Two-level pedicle subtraction osteotomy is a high-risk and high-demand operation that needs to be performed by an experienced spinal surgery team.
VL  - 10
IS  - 3
ER  -

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Author Information

Yongchun Xiao

Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
Gengxiong Lin

Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
Guowei Zhang

Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
Hua Yang

Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
Zhisheng Ji

Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China
Hongsheng Lin

Department of Orthopedics, the First Affiliated Hospital of Jinan University, Guangzhou, China

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APA Style

Yongchun Xiao, Gengxiong Lin, Guowei Zhang, Hua Yang, Zhisheng Ji, et al. (2022). A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy. Journal of Surgery, 10(3), 131-135. https://doi.org/10.11648/j.js.20221003.18

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ACS Style

Yongchun Xiao; Gengxiong Lin; Guowei Zhang; Hua Yang; Zhisheng Ji, et al. A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy. J. Surg. 2022, 10(3), 131-135. doi: 10.11648/j.js.20221003.18

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AMA Style

Yongchun Xiao, Gengxiong Lin, Guowei Zhang, Hua Yang, Zhisheng Ji, et al. A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy. J Surg. 2022;10(3):131-135. doi: 10.11648/j.js.20221003.18

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@article{10.11648/j.js.20221003.18,
  author = {Yongchun Xiao and Gengxiong Lin and Guowei Zhang and Hua Yang and Zhisheng Ji and Hongsheng Lin},
  title = {A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy},
  journal = {Journal of Surgery},
  volume = {10},
  number = {3},
  pages = {131-135},
  doi = {10.11648/j.js.20221003.18},
  url = {https://doi.org/10.11648/j.js.20221003.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20221003.18},
  abstract = {Ankylosing spondylitis is a disease characterized by inflammation of sacroiliac joint and spinal attachment point. It is strongly associated with HLA-B27. About 30% of patients will develope kyphosis. It not only causes severe kyphosis, restricted mobility, ugly appearance, and human head-up disorder, but also severe kyphosis causes sleep difficulties, compression of the chest and abdominal organs, and abdominal muscles. Contractures lead to disorders of the digestive function of the gastrointestinal tract and superior mesenteric artery syndrome, and even more serious psychological disorders, and even loss of confidence in life. The most effective treatment for ankylosing spondylitis kyphosis is spinal orthopedics. We report a 38-year-old male patient who was hospitalized with ankylosing spondylitis and kyphosis due to low back pain and activity limitation for 20 years, and progressive aggravation of his kyphosis for 10 years. The measurement of preoperative imaging parameters indicated: Pelvic Incidence (PI) = 61°, Pelvic Tilt (PT) = 64°, Sacral Slope (SS) = -3°, Lumbar Lordosis (LL) = -25°, Thoracolumbar Junction (TLJ) = 45°, Thoracic Kyphosis (TK) = 65°, Chin-Brow Vertical Angle (CBVB) = 60°. With adequate preoperative planning and discussion, we performed a two-level pedicle subtraction osteotomy, which requires comprehensive perioperative care and more refined intraoperative manipulation. The postoperative patient was 169cm, the height increased by 32cm, postoperative parameter measurement, PI = 60°, PT = 38°, SS = 22°, LL = 52°, TLJ = 15°, TK = 19°, CBVB = 13°. After the operation, the patient recovered well, the treatment effect was satisfactory, and the quality of life was significantly improved. Two-level pedicle subtraction osteotomy is a high-risk and high-demand operation that needs to be performed by an experienced spinal surgery team.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - A Case Study on Treatment of Ankylosing Spondylitis with Kyphosis Deformity by Two-Level Pedicle Subtraction Osteotomy
AU  - Yongchun Xiao
AU  - Gengxiong Lin
AU  - Guowei Zhang
AU  - Hua Yang
AU  - Zhisheng Ji
AU  - Hongsheng Lin
Y1  - 2022/06/30
PY  - 2022
N1  - https://doi.org/10.11648/j.js.20221003.18
DO  - 10.11648/j.js.20221003.18
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 131
EP  - 135
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20221003.18
AB  - Ankylosing spondylitis is a disease characterized by inflammation of sacroiliac joint and spinal attachment point. It is strongly associated with HLA-B27. About 30% of patients will develope kyphosis. It not only causes severe kyphosis, restricted mobility, ugly appearance, and human head-up disorder, but also severe kyphosis causes sleep difficulties, compression of the chest and abdominal organs, and abdominal muscles. Contractures lead to disorders of the digestive function of the gastrointestinal tract and superior mesenteric artery syndrome, and even more serious psychological disorders, and even loss of confidence in life. The most effective treatment for ankylosing spondylitis kyphosis is spinal orthopedics. We report a 38-year-old male patient who was hospitalized with ankylosing spondylitis and kyphosis due to low back pain and activity limitation for 20 years, and progressive aggravation of his kyphosis for 10 years. The measurement of preoperative imaging parameters indicated: Pelvic Incidence (PI) = 61°, Pelvic Tilt (PT) = 64°, Sacral Slope (SS) = -3°, Lumbar Lordosis (LL) = -25°, Thoracolumbar Junction (TLJ) = 45°, Thoracic Kyphosis (TK) = 65°, Chin-Brow Vertical Angle (CBVB) = 60°. With adequate preoperative planning and discussion, we performed a two-level pedicle subtraction osteotomy, which requires comprehensive perioperative care and more refined intraoperative manipulation. The postoperative patient was 169cm, the height increased by 32cm, postoperative parameter measurement, PI = 60°, PT = 38°, SS = 22°, LL = 52°, TLJ = 15°, TK = 19°, CBVB = 13°. After the operation, the patient recovered well, the treatment effect was satisfactory, and the quality of life was significantly improved. Two-level pedicle subtraction osteotomy is a high-risk and high-demand operation that needs to be performed by an experienced spinal surgery team.
VL  - 10
IS  - 3
ER  -

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