PDF
ePub
Citation
Print
Abstract
Objective
We evaluated the radiologic changes and quality of life after corrective osteotomy in kyphotic deformity of ankylosing spondylitis.
Summary of Literature Review
There is few study about that relationship between corrective osteotomy and quality of life.
Materials and Methods
Retrospective study about 16 patients who underwent corrective osteotomy from 2005 September to 2007 December was done. Radiologic assessments of sagittal balance were performed on the criteria of thoracic kyphosis, lumbar lordosis, distance between the vertical line on midpoint of C7 and posterosuperior point of S1 pre and postoperatively. Disease specific instruments: the Bath ankylosing spondylitis disease activity index (BASDAI) and the Bath ankylosing spondylitis functional index (BASFI) were applied. Clinical assessments were performed with short form-36 through interview and telephone.
Results
The mean thoracic kyphosis was changed from 46.1 degrees to 39.3 degrees. The mean lumbar lordosis was corrected from - 7.4 degrees to - 38.4 degrees, and the mean distance between vertical lines of C7 and S1 was improved from 127.1mm to 30mm. There were significant changes in the subgroup of Physical function, Role physical, Vitality, Social function, Role emotional, Mental health. (p<0.05) The changes of BASDAI, BASFI, Bodily pain and General health were not significant. And similar improvements in the radiological results and SF-36 scores were in the 6 patients with Andersson lesion.
REFERENCES
1. Turan Y, Duruö z MT, Cerrahoglu L. Quality of life in patients with ankylosing spondylitis: a pilot study. Rheumatol Int. 2007; 27:895–9.
2. Ozdemir O. Quality of life in patients with ankylosing spondylitis: relationships with spinal mobility, disease activity and functional status. Rheumatol Int. 2010 Jan 5. [Epub ahead of print].
3. Bradford DS, Schumacher WL, Lonstein JE, Winter RB. Ankylosing spondylitis: experience in surgical management of 21 patients. Spine. 1987; 12:238–43.
4. Van Royen BJ, De Gast A. Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis. 1999; 58:399–406.
5. Niemeyer T, Hackenberg L, Bullmann V, Liljenqvist U, Halm H. Technique and results of monosegmental transpedicular subtraction osteotomy in patients with ankylosing spondylitis and fixed kyphotic deformity of the spine. Z Orthop Ihre Grenzgeb. 2002; 140:176–81.
6. Yoo MC, Lee SE, Kim KT, Lee HK, Cho JH. Clinical and Radiological Features of Ankylosing Spondylitis. J Korean Soc Spine Surg. 1995; 2:72–80.
7. Kim KT, Cho YJ, Hong GP, Park BJ, Lee JH. Clinical Results after Corrective Osteotomy of the Kyphotic Deformity in Ankylosing Spondylitis. J Korean Soc Spine Surg. 2000; 7:61–9.
8. Lillegraven S, Kvien TK. Measuring disability and quality of life in established rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007; 21:827–40.
9. Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994; 21:2286–91.
10. Calin A, Garrett S, Whitelock H, et al. A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol. 1994; 21:2281–5.
11. Ware JE Jr. SF-36 health survey update. Spine. 2000; 25:3130–9.
12. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res. 1969; 66:6–9.
13. Halm H, Metz-Stavenhagen P, Zielke K. Results of surgical correction of kyphotic deformities of the spine in ankylosing spondylitis on the basis of the modified arthritis impact measurement scales. Spine. 1995; 20:1612–9.
14. Meenan RF, Gertman PM, Mason JH. Measuring health status in arthritis. The arthritis impact measurement scales. Arthritis Rheum. 1980; 23:146–52.
15. Haywood KL, Garratt AM, Dawes PT. Patient-assessed health in ankylosing spondylitis: a structured review. Rheumatology. 2005; 44:577–86.
16. Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ. 1993; 2:217–27.
17. Essink-Bot ML, Krabbe PF, Bonsel GJ, Aaronson NK. An empirical comparison of four generic health status measures. The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/WONCA charts, and the EuroQol instrument. Med Care. 1997; 35:522–37.
18. Fang D, Leong JC, Ho EK, Chan FL, Chow SP. Spinal pseudarthrosis in ankylosing spondylitis. Clinicopathological correlation and the results of anterior spinal fusion J Bone Joint Surg Br. 1988; 70:443–7.
19. Kim KT, Suk KS, Lee SH, Bae SC. The treatment of spinal pseudoarthrosis in ankylosing spondylitis. J Korean Orthop Assoc. 2005; 40:312–20.
Figures and Tables%
Fig 1.
Significant improvements were seen 6 categories (physical function, role physical, vitality, social function, role emotional, mental health) after corrective osteotomy(p-value<0.05). There were also improvements in bodily pain and general health, but those were not significant (p-value=0.263, p-value=0.314).
Fig 2.
Improvement in mental component summary was better than that in physical component summary (p-value<0.05).
Table 1.
Demographic data
Table 2.
Radiologic results after corrective osteotomy
| Preoperative | Postoperative | |
|---|---|---|
| Thoracic kyphosis(°) | 46.1(28~70) | 39.3(20~59) |
| Lumbar lordosis(°) | -7.4(-12~0) | -38.4(-51~-31) |
| Distance between C7 plumb line and S1 | 127.1(59~203) | 30.0(0~55) |
Table 3.
The Bath ankylosing spinal functional index† and the Bath ankylosing spondylitis disease activity index†† were not changed significantly after corrective osteotomy.
| Preoperative | Postoperative | P-value | |
|---|---|---|---|
| BASFI† | 6.0±1.9 | 5.0±1.0 | 0.45 |
| BASDAI†† | 5.9±2.0 | 4.8±2.1 | 0.53 |
Table 4.
There were not significant change between the groups of patients with thoracic kyphotic deformity and Andersson lesion and the groups of patients with thoracic kyphotic deformity in radiologic parameters (*p-value=0.36, **p-value=0.14, ***p-value=0.62).
XML Download