Pedicle subtraction osteotomy in lateral decubitus position to correct severe kyphosis in patient with ankylosing spondylitis-Case report

Chien-Ming Chin ； Shiau-Tzu Tzeng

《Formosan Journal of Musculoskeletal Disorders》 10卷2期 (2019/05) Pp. 69-73

https://doi.org/10.6492/FJMD.201905_10(2).0004

摘要

The treatment of kyphotic deformity in patient with ankylosing spondylitis (AS) is challenging and usually requires spinal osteotomies. Usually the corrective surgeries were performed in prone position. However, in some circumstances, it might be easier to perform the operation in lateral decubitus position. We report a case that the deformity correction was performed in this posture. The 53 year-old obese male is a case of AS and congestive heart failure. He received L3 pedicle subtraction osteotomy (PSO) with L1-5 instrumented fusion at age 34 due to kyphosis on his back. At age 52, he suffered from T6/7 pseudoarthrosis with global kyphosis. The obesity, severe deformity, poor cardiac function make positioning of operation become critical for him. Therefore, he received instrumented fusion from T4 to T10 in lateral decubitus position. One year after surgery for T6/7 pseudoarthrosis, he suffered from implant failure over T8/9 levels with pseudoarthrosis. Obviously similar problem would be encountered if the kyphotic deformity was not corrected. This time we perform PSO over L1 in lateral decubitus position. After surgery, the global kyphotic angle was decreased from 84° preoperatively to 40°. The postoperative course was complicated with wound infection and implant failure, which were resolved after further surgeries. The lateral decubitus position could offer several advantages: position with ease, decrease the difficulty during anesthesia and maintain a clear airway, decrease blood loss due to less abdominal pressure, the oozing blood flows away from the depths instead of into them, and eliminates risk of injury to ankylosed cervical spine by pressure of the forehead against the table in prone position. Although most of the spinal osteotomies were performed in prone position, the lateral decubitus position has some advantages. It could be a feasible alternative option in some circumstances.

關鍵字

ankylosing spondylitis ； lateral decubitus position ； pedicle subtraction osteotomy