Screw placement in repair of ankylosing spondylitis complicated by severe wheel-like kyphosis: stress distribution in multiple segments

doi:10.3969/j.issn.2095-4344.2015.13.019

Abstract

Abstract:

BACKGROUND: Kyphotic deformity in ankylosing spondylitis is the flexion deformity of spine sagittal plane in the late lesion. Spinal osteotomy is the only treatment method in patients with severe wheel-like kyphosis. For thoracic and thoracolumbar ankylosing spondylitis patients with lumbar severe wheel-like kyphosis, osteotomy at a single site cannot obtain safe and effective orthopedic effect.
OBJECTIVE: To observe the orthopedic effect of total spine osteotomy combined with V-shaped osteotomy for correction of severe wheel-like kyphosis deformity due to ankylosing spondylitis, and to analyze stress distribution.
METHODS: From May 2003 to October 2012, total spine osteotomy combined with V-shaped osteotomy and pedicle screw fixation were adopted for repair of concurrent thoracic, thoracolumbar and lumbar severe wheel-like kyphosis deformity due to ankylosing spondylitis in 36 male cases in the Sixth Affiliated Hospital of Xinjiang Medical University. Spinal convex angle, chin-brow vertical angle and C7 plumb line were measured to evaluate orthopedic effect.
RESULTS AND CONCLUSION: The whole spine convex Cobb angle was corrected from preoperatively (89.6±9.8)° to (32.2±6.7)° at 1 week after treatment, showing significant difference (P < 0.05), with an average correction rate of 64%. The chin-brow vertical angle was 9.6° averagely after correction (P < 0.05), with an average correction rate of 76%. The C7 plumb line was 4.4 cm averagely after correction (P < 0.05), with an average correction rate of 81%. After follow-up of 24-48 months, no significant difference in above indexes was detected during final follow-up and 1 week postoperatively (P > 0.05). Radiographs demonstrated that fixation position was good in all patients. These results confirmed that in patient with severe wheel-like kyphosis deformity due to ankylosing spondylitis, the application of total spine osteotomy combined with V-shaped osteotomy is a safe and effective method, can better correct the spinal sagittal curvature and reduce the risk of sagittal angle, result in the stress distribution in many segments and the shortening of the spine and epidural buckling in relatively long segment, can avoid nerve damage induced by spinal cord shortening and epidural excessive buckling within short segment.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Spondylitis, Ankylosing, Kyphosis, Osteotomy, Bone Nails, Internal Fixators

CLC Number:

R318

Ma Jun-yi, Yang Jing, Ma Yuan, Tian Hui-zhong. Screw placement in repair of ankylosing spondylitis complicated by severe wheel-like kyphosis: stress distribution in multiple segments[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(13): 2069-2074.

Figures/Tables 3

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