Curative effect of pedicle subtraction osteotomy combined with satellite rod for thoracolumbar kyphosis secondary to ankylosing spondylitis
Lu Jingshun, Qian Bangping, Qiu Yong, Wang Bin, Yu Yang, Qiao Mu
Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nangjing 210008, China
Abstract：Objective This study aims to investigate the clinical outcomes of pedicle subtraction osteotomy (PSO) combined with satellite rod technique in the treatment of thoracolumbar kyphosis in ankylosing spondylitis (AS). Methods This study adopted a retrospective cohort. Twenty-nine patients with AS (26 males and 3 females) who underwent single-level PSO combined with satellite rod technique in the Drum Tower Hospital of Nanjing University Medical School from September 2016 to June 2021 were retrospectively reviewed. The patients had an average age of 18 to 55 (35.5±9.9) years and divided into two groups according to the use of satellite rod unilaterally or bilaterally around the osteotomy area: 13 patients were in the unilateral group and 16 patients were in the bilateral group. Observation indicators included the following. (1) The corrective effect of patients was measured based on lateral full-spine X-ray. Radiographic parameters including sagittal vertical axis (SVA), lumbar lordosis (LL), and global kyphosis (GK) were compared between the two groups preoperatively, postoperatively, and at the last follow-up. Osteotomized vertebral angle (OVA) and angle of fused segments (AFS) were compared postoperatively and at the final follow-up. (2) The incidence of complications between the two groups was compared and the mechanical complication of rod breakage were observed. Results No statistical difference was observed in age, gender, and follow-up period between the two groups (all P values>0.05). Twenty-nine patients with AS received surgical treatment successfully and were followed up for 12-72 (26.4±10.7)months. (1) Based on comparison of data within the group, the postoperative SVA, GK, and LL were (64.1±42.5) mm, 34.4°±20°, and -44.0°±10.8°, respectively, and at the last follow-up values were (64.2±51.6) mm, 34.7°±18.4°, and -39.3°±11.9°, respectively, and before surgery, they were (162.1±53.3) mm, 79.7°±16.8°, -9.5°±20.4°, respectively in the unilateral group. In the bilateral group, the postoperative SVA, GK, and LL were (53.9±45.9) mm, 24.9°±14.0°, and -40.7°±9.2°, and the values at the last follow-up were (48.6±48.5) mm, 25.6°±15.7°, and -39.8°±8.5°, respectively, and before surgery they were (155.4±66.7) mm, 68.3°±15.3°, 0.6°±18.1°, respectively. All of above-mentioned parameters were significantly improved compared with the preoperative values, and the differences were statistically significant (all P values<0.05). However, no significant difference was observed between the final follow-up and immediate postoperative parameters (all P values>0.05). Based on comparison of data between two groups (SVA, GK, LL, AFS), no statistically significant difference was detected in the radiographic parameters, except that the postoperative OVA was significantly greater in the bilateral group (28.6°±8.8° vs. 19.9°±10.4°, t=-2.42, P=0.023). (2) Surgical complications occurred in four of the 29 patients. The complications in the unilateral group included 1 case of rod fracture on the side without satellite rod at the level of the osteotomized vertebra that occurred in 6 years after operation and 1 case of postoperative positional brachial palsy. The bilateral group included 2 cases of osteotomized vertebral subluxation. The incidence of complications was not significantly different between the two groups (P=1.000). Conclusion The application of PSO combined with satellite rod technique in the treatment of AS-related thoracolumbar kyphosis could achieve satisfactory correction and effectively prevent mechanical complications and correction loss.
陆景顺, 钱邦平, 邱勇, 王斌, 俞杨, 乔木. 经椎弓根截骨术联合卫星棒治疗强直性脊柱炎胸腰椎后凸畸形的疗效观察[J]. 中华解剖与临床杂志, 2024, 29(1): 29-35.
Lu Jingshun, Qian Bangping, Qiu Yong, Wang Bin, Yu Yang, Qiao Mu. Curative effect of pedicle subtraction osteotomy combined with satellite rod for thoracolumbar kyphosis secondary to ankylosing spondylitis. Chinese Journal of Anatomy and Clinics, 2024, 29(1): 29-35.
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2024, Vol. 29 
