J Korean Soc Spine Surg.  2015 Jun;22(2):43-49. 10.4184/jkss.2015.22.2.43.

Clinical Value of Visualized Prediction of Corrective Osteotomy of Ankylosing Spondylitis

• Lee J
• Kim H
• Park YS

• KMID: 2322951
• DOI: http://doi.org/10.4184/jkss.2015.22.2.43

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To evaluate the clinical value of preoperative planning via computer simulation by comparing preoperative and postoperative measurements of a patient with ankylosing spondylitis. SUMMARY OF LITERATURE REVIEW: Ankylosing spondylitis is a disorder that results in a spinal deformity because chronic inflammation at the ligament attachment sites triggers ossification; it causes round fixed kyphosis. This causes limitations in not only everyday life but also social interaction because it is impossible for patients to face forward. Therefore, surgical correction is necessary.
MATERIALS AND METHODS
We analyzed 38 patients (41 instances) who underwent correctional osteotomy between June 2007 and March 2014 to treat kyphosis caused by ankylosing spondylitis. We chose the appropriate operation site on the basis of preoperative simulations of osteotomy and the site for pre- and postoperative radiological evaluations conducted from the lateral view in a standing position. For the clinical evaluation, Bath Ankylosing Spondylitis Function Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Hospital Anxiety and Depression Survey (HADS), and Health Locus of Control Form C Questionnaire (HLC-C) were used.
RESULTS
The mean sagittal vertical axis (SVA) was improved from 123.4 mm to 66.1 mm, the mean thoracic kyphosis angle (TKA) changed from 42.2degrees to 40.1degrees, and the mean lumbar lordosis angle (LLA) improved from 16.0degrees to 28.5degrees. The correlation coefficients between the preoperative predictive value and the postoperative radiographic measurement were 0.43, 0.93, and 0.87, which were all statistically significant.
CONCLUSIONS
By comparing the preoperative measurement with the postoperative radiologic score, we found that the two were correlated and that the clinical assessment improved on the basis of the visualization. Therefore, preoperative simulation of patients with ankylosing spondylitis along with a kyphotic deformity is thought to be clinically effective.

Keyword

Ankylosing spondylitis; Simulations of osteotomy; Preoperative planning

MeSH Terms

Animals
Anxiety
Axis, Cervical Vertebra
Baths
Computer Simulation
Congenital Abnormalities
Depression
Humans
Inflammation
Internal-External Control
Interpersonal Relations
Kyphosis
Ligaments
Lordosis
Osteotomy*
Surveys and Questionnaires
Retrospective Studies
Spondylitis, Ankylosing*

Figure

• 

  Fig. 1. A 50-year-old man visited our institution complaining of back pain (Case 32). The preoperative sagittal vertical axis (SVA) was 137.63 mm, thoracic kyphosis angle (TKA) was 56°, and lumbar lordosis angle (LLA) was 16°. We simulated osteotomy that corrected a T12 and L3 pedicle subtraction osteotomy (PSO) combination and a T12 and L4 PSO combination; several other simulations were conducted as well. We found that the T12 and L4 PSO combination exhibited the best result. The estimated SVA was 75.22 mm, TKA was 34°, and LLA was 40°.

• 

  Fig. 2. Preoperative and 2-week postoperative radiological evaluations. The sagittal vertical axis (SVA) was corrected to 66.0 mm, thoracic kyphosis angle (TKA) was 37°, and lumbar lordosis angle (LLA) was 38°; these values were almost the same as those of the preoperative simulation.

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