Radiographic findings for surgery-related complications after pedicle subtraction osteotomy for thoracolumbar kyphosis in 230 patients with ankylosing spondylitis

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  • 1 Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul; and
  • 2 Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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OBJECTIVE

The purpose of this study was to investigate the rate of and the risk factors for surgery-related complications demonstrated on radiography after pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis in patients with ankylosing spondylitis (AS).

METHODS

The authors retrospectively reviewed the medical records of 230 consecutive patients with thoracolumbar kyphosis due to AS who had undergone 1-level PSO at a single institution in the period from 2010 to 2017. The causes of surgery-related complications were divided into two types: surgical/technical failure and mechanical failure.

RESULTS

The patients consisted of 20 women and 210 men, with an average age of 43.4 years. The average follow-up period was 39.0 months. The preoperative sagittal vertical axis was 18.5 ± 69.3 cm, which improved to 4.9 ± 4.6 cm after PSO. Of the 77 patients (33.5%) who experienced minor or major surgery-related complications, 56 had complications related to surgical/technical failure (overall incidence 24.3%) and 21 had complications related to mechanical failure (overall incidence 9.1%). Fourteen patients (6.1%) underwent reoperation. However, among the 77 patients with complications, the rate of revision surgery was 18.2%. The most common radiological complications were as follows: sagittal translation in 24 patients, coronal imbalance in 20, under-correction in 8, delayed union in 8, and distal junctional failure and kyphosis in 8. The most common causes of reoperation were coronal imbalance in 4 patients, symptomatic malposition of pedicle screws in 3, and distal junctional failure in 3. Delayed union was statistically correlated with posterior sagittal translation (p = 0.007).

CONCLUSIONS

PSO can provide acceptable radiographic outcomes for the correction of thoracolumbar kyphosis in patients with AS. However, a high incidence of surgery-related complications related to mechanical failure and surgical technique can develop. Thorough radiographic investigation before and during surgery is needed to determine whether complete ossification occurs along the anterior and posterior longitudinal ligaments of the spine.

ABBREVIATIONS ALL = anterior longitudinal ligament; AS = ankylosing spondylitis; CI = coronal imbalance; DJA = distal junctional angle; DJF = distal junctional failure; DJK = distal junctional kyphosis; LIV = lower instrumented vertebra; PJA = proximal junctional angle; PJF = proximal junctional failure; PJK = proximal junctional kyphosis; PSO = pedicle subtraction osteotomy; SVA = sagittal vertical axis; UIV = upper instrumented vertebra.

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Contributor Notes

Correspondence Kee-Yong Ha: College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea. kyh@catholic.ac.kr.

INCLUDE WHEN CITING Published online May 15, 2020; DOI: 10.3171/2020.3.SPINE191355.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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