Staged cervical osteotomy:a new strategy for correcting ankylosing spondylitis thoracolumbar kyphotic deformity with fus
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(2019) 14:108
RESEARCH ARTICLE
Open Access
Staged cervical osteotomy:a new strategy for correcting ankylosing spondylitis thoracolumbar kyphotic deformity with fused cervical spine Tianhao Wang1,2†, Diyu Song3,2†, Guoquan Zheng2* and Yan Wang2*
Abstract Background: In patients with cervical ankylosis, the chin-brow vertical angle (CBVA) should be taken into consideration. Usually, the correction of sagittal balance is sacrificed to ensure the patient has a horizontal visual field. To our knowledge, a staged osteotomy strategy for ankylosing spondylitis kyphotic deformity with an ankylosed cervical spine has not been reported before. The aim of this study was to describe a new surgical strategy with emphasis on sagittal balance and gaze angle in correction of kyphotic deformity with a rigid cervical spine in ankylosing spondylitis thoracolumbar kyphotic deformity. Methods: A 36-year-old man has severe thoracolumbar kyphosis accompanied with cervical hyperlordosis caused by ankylosing spondylitis. A two-stage surgery planning was managed. For the first stage, an interrupted twolevel osteotomy was performed at the thoracolumbar area. After surgery, sagittal imbalance was corrected but the CBVA was − 21.7°. Cervical osteotomy was performed for the second stage. A flexion osteotomy was performed at C7, using anterior-posterior-anterior approaches. Results: Both sagittal imbalance and gaze angle of the patient were improved markedly. The osteotomy sites were documented fused. Complications were not observed during and after operation. Conclusions: The aim of osteotomy for ankylosing spondylitis is to reestablish sagittal balance and improve forward gaze and the visual field. A staged cervical osteotomy is an alternative to reduce cervical lordosis to obtain a normal gaze angle. An anterior-posterior-anterior approach is recommended. Keywords: Ankylosing spondylitis, Deformity, Kyphosis, Thoracolumbar kyphosis, Cervical hyperlordosis, Osteotomy, Cervical osteotomy, Sagittal balance, Chin-brow vertical angle
Introduction Ankylosing spondylitis (AS) causes characteristic spinal deformity leading to impaired ability of walking, standing, and looking straight ahead in the late stages [1, 2]. Since Smith-Petersen [3] performed an opening wedge lumbar osteotomy for AS flexion deformity, more and more researches about osteotomy techniques were reported. The main purpose of corrective osteotomy is a * Correspondence: [email protected]; [email protected] † Tianhao Wang and Diyu Song contributed equally to this work and should be considered as co-first authors 2 Department of Orthopaedics, General Hospital of Chinese People’s Liberation Army, Fuxing Road, Beijing 100853, China Full list of author information is available at the end of the article
good correction of sagittal balance, which is recommended in most of papers to be achieved by one or two-level osteotomy in the lumbar or lower thoracic spine [1–4]. Suk et al. [5] firstly noted that the chin-brow vertical angle (CBVA) was significant in the correction of AS deform
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