Journal List > J Korean Soc Spine Surg > v.22(2) > 1076075

J Korean Soc Spine Surg. 2015 Jun;22(2):43-49. Korean.
Published online June 30, 2015.  https://doi.org/10.4184/jkss.2015.22.2.43
© Copyright 2015 Korean Society of Spine Surgery
Clinical Value of Visualized Prediction of Corrective Osteotomy of Ankylosing Spondylitis
Jaewon Lee, M.D., Hunchul Kim, M.D. and Ye-Soo Park, M.D.
Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, Korea.

Corresponding author: Ye-Soo Park, M.D. Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, 153, Gyungchun-ro(St), Guri city, Gyunggi-do, 471-701, Korea. TEL: +82-31-560-2317, FAX: +82-31-557-8781, Email: hyparkys@hanyang.ac.kr
Received July 14, 2014; Revised September 22, 2014; Accepted May 19, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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 42.2° to 40.1°, and the mean lumbar lordosis angle (LLA) improved from 16.0° to 28.5°. 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.

Keywords: Ankylosing spondylitis; Simulations of osteotomy; Preoperative planning

Figures


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°.
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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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Tables


Table 1
Demographics of Patients
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Table 2
Improvement of radiologic parameter after surgery
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Table 3
Agreement between simulated and postoperative values
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