Sagittal Rotation with Translation in Opening Wedge Osteotomy for the Correction of Thoracolumbar Kyphotic Deformity in Ankylosing Spondylitis

Purpose: Surgeons recognize displacement at the hinge of correction in opening wedge osteotomy (OWO) as an accidental and unwanted event between the vertebrae on the side of OWO rather than sagittal rotation with translation of the cranial or caudal vertebral column. No report documents sagittal translation (ST) in OWO to treat AS kyphosis. The purpose was to document the frequency and nature of ST during OWO and to consider its implications, predisposing factors and complications. Methods: Radiographic and clinical results of 127 patients (average age, 35.2 yr; range, 17-49 yr) undergoing OWO for AS kyphosis were analyzed. ST was displacement of more than 2 mm between the cranial and caudal vertebral columns at the level of OWO. Mean follow-up was 5.1 yr (range, 2.1-8.9 yr). Results: ST was demonstrated in 27% of patients. In 94%, the apex of kyphotic deformity was between T11 and L4. Incidence of ST was positively correlated with the correction of lumbar lordosis and preoperative lumbar kyphosis. Incidence of neurological complication was 15% (5/34) in the group in presence of ST compared to 2.1% (2/93) in absence of ST. Conclusion: ST is one of the basic mechanisms of correcting sagittal imbalance by OWO. ST is more likely to occur when the level of OWO is closer to the apex of the deformity. Patients needing more correction of lumbar lordosis to approximate the best possible correction of sagittal imbalance need ST more so than others to join the mechanism of correction by OWO. Pediculectomy to prevent nerve root compression is recommended to be performed as a routine procedure before the correction maneuver for patients predisposed to develop ST.

並列關鍵字

ankylosing spondylitis ； opening wedge osteotomy ； pediculectomy ； sagittal translation

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