Variation patterns of cervical alignment in ankylosing spondylitis–related thoracolumbar kyphosis following pedicle subtraction osteotomy in the sitting position: an EOS-based investigation

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  • Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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OBJECTIVE

Both unchanged upper cervical lordosis combined with decreased lower cervical lordosis and decreased upper cervical lordosis combined with decreased lower cervical lordosis have been reported to occur after correction surgery for adult spinal deformity. However, variations in cervical alignment after correction surgery in patients with ankylosing spondylitis (AS) have not been investigated. The current study aimed to investigate the variations in cervical alignment following the correction surgery in AS patients with thoracolumbar kyphosis.

METHODS

Patients with AS who underwent pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis from June 2016 to June 2019 with a minimum of 1-year follow-up were reviewed. Patients were grouped according to the presence (ossified group) and absence (non-ossified group) of total ossification of the anterior longitudinal ligament (ALL) in the lower cervical spine. Radiographic parameters, including thoracolumbar, craniocervical, and global radiographic parameters, were measured on lateral sitting EOS images.

RESULTS

Thirty-two patients (27 males and 5 females) with a mean follow-up of 1.5 years were identified. There were 21 patients in the non-ossified group and 11 patients in the ossified group. After PSO, both groups showed a decrease in the occiput–C7 angle (p < 0.001 for both). In the non-ossified group, the C2–7 angle decreased significantly (p < 0.001), while the occiput–C2 angle remained unchanged (p = 0.570). In the ossified group, the occiput–C2 angle decreased significantly (p < 0.001), while C2–7 angle remained unchanged (p = 0.311). In addition, the change in occiput–C2 was correlated with the osteotomy angle in the ossified group (R = 0.776, p = 0.005).

CONCLUSIONS

The variation patterns of cervical alignment following correction surgery for AS-related thoracolumbar kyphosis were different based on patients with or without total ossification of ALL in the lower cervical spine. When planning PSO for patients in the ossified group, restoration of the physiological upper cervical lordosis angle could be achieved by adjusting the osteotomy angle.

ABBREVIATIONS

ALL = anterior longitudinal ligament; AS = ankylosing spondylitis; ASD = adult spinal deformity; LL = lumbar lordosis; PSA = pedicle subtraction angle; PSO = pedicle subtraction osteotomy; SVA = sagittal vertical axis.

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Contributor Notes

Correspondence Yong Qiu: Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. scoliosis2002@sina.com.

INCLUDE WHEN CITING Published online May 28, 2021; DOI: 10.3171/2020.11.SPINE201420.

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

  • 1

    Qian BP, Qiu Y, Wang B, et al. . Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis. Eur Spine J. 2012;21(4):711718.

    • Search Google Scholar
    • Export Citation
  • 2

    Deminger A, Klingberg E, Lorentzon M, et al. . Which measuring site in ankylosing spondylitis is best to detect bone loss and what predicts the decline: results from a 5-year prospective study. Arthritis Res Ther. 2017;19(1):273.

    • Search Google Scholar
    • Export Citation
  • 3

    Lafage V, Ames C, Schwab F, et al. . Changes in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy: a comprehensive radiographic analysis. Spine (Phila Pa 1976).2012;37(3):E180E187.

    • Search Google Scholar
    • Export Citation
  • 4

    Klineberg E, Schwab F, Smith JS, et al. . Sagittal spinal pelvic alignment. Neurosurg Clin N Am. 2013;24(2):157162.

  • 5

    Obeid I, Boniello A, Boissiere L, et al. . Cervical spine alignment following lumbar pedicle subtraction osteotomy for sagittal imbalance. Eur Spine J. 2015;24(6):11911198.

    • Search Google Scholar
    • Export Citation
  • 6

    Cecchinato R, Langella F, Bassani R, et al. . Variations of cervical lordosis and head alignment after pedicle subtraction osteotomy surgery for sagittal imbalance. Eur Spine J. 2014;23(suppl 6):644649.

    • Search Google Scholar
    • Export Citation
  • 7

    Qian J, Qiu Y, Qian BP, et al. . Compensatory modulation for severe global sagittal imbalance: significance of cervical compensation on quality of life in thoracolumbar kyphosis secondary to ankylosing spondylitis. Eur Spine J. 2016;25(11):37153722.

    • Search Google Scholar
    • Export Citation
  • 8

    MacKay K, Brophy S, Mack C, et al. . The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index. J Rheumatol. 2000;27(12):28662872.

    • Search Google Scholar
    • Export Citation
  • 9

    Creemers MC, Franssen MJ, van’t Hof MA, et al. . Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis. 2005;64(1):127129.

    • Search Google Scholar
    • Export Citation
  • 10

    Kim YJ, Bridwell KH, Lenke LG, et al. . Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976).2007;32(20):21892197.

    • Search Google Scholar
    • Export Citation
  • 11

    Koller H, Koller J, Mayer M, et al. . Osteotomies in ankylosing spondylitis: where, how many, and how much?. Eur Spine J. 2018;27(1)(suppl 1):70100.

    • Search Google Scholar
    • Export Citation
  • 12

    Huang JC, Qian BP, Qiu Y, et al. . What is the optimal postoperative sagittal alignment in ankylosing spondylitis patients with thoracolumbar kyphosis following one-level pedicle subtraction osteotomy?. Spine J. 2020;20(5):765775.

    • Search Google Scholar
    • Export Citation
  • 13

    Scheer JK, Tang JA, Smith JS, et al. . Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013;19(2):141159.

    • Search Google Scholar
    • Export Citation
  • 14

    Paternostre F, Charles YP, Sauleau EA, Steib JP. Cervical sagittal alignment in adult hyperkyphosis treated by posterior instrumentation and in situ bending. Orthop Traumatol Surg Res. 2017;103(1):5359.

    • Search Google Scholar
    • Export Citation
  • 15

    Kim SB, Heo YM, Hwang CM, et al. . Reliability of the EOS imaging system for assessment of the spinal and pelvic alignment in the sagittal plane. Clin Orthop Surg. 2018;10(4):500507.

    • Search Google Scholar
    • Export Citation
  • 16

    Lazennec JY, Brusson A, Rousseau MA. Hip-spine relations and sagittal balance clinical consequences. Eur Spine J. 2011;20(suppl 5):686698.

    • Search Google Scholar
    • Export Citation
  • 17

    Barrey C, Roussouly P, Le Huec JC, et al. . Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J. 2013;22(suppl 6):S834S841.

    • Search Google Scholar
    • Export Citation
  • 18

    Ramchandran S, Protopsaltis TS, Sciubba D, et al. . Prospective multi-centric evaluation of upper cervical and infra-cervical sagittal compensatory alignment in patients with adult cervical deformity. Eur Spine J. 2018;27(2):416425.

    • Search Google Scholar
    • Export Citation
  • 19

    Smith JS, Shaffrey CI, Lafage V, et al. . Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy. J Neurosurg Spine. 2012;17(4):300307.

    • Search Google Scholar
    • Export Citation
  • 20

    Tan S, Yao J, Flynn JA, et al. . Zygapophyseal joint fusion in ankylosing spondylitis assessed by computed tomography: associations with syndesmophytes and spinal motion. J Rheumatol. 2017;44(7):10041010.

    • Search Google Scholar
    • Export Citation
  • 21

    Miyamoto H, Hashimoto K, Ikeda T, Akagi M. Effect of correction surgery for cervical kyphosis on compensatory mechanisms in overall spinopelvic sagittal alignment. Eur Spine J. 2017;26(9):23802385.

    • Search Google Scholar
    • Export Citation
  • 22

    Ruangchainikom M, Daubs MD, Suzuki A, et al. . Effect of cervical kyphotic deformity type on the motion characteristics and dynamic spinal cord compression. Spine (Phila Pa 1976).2014;39(12):932938.

    • Search Google Scholar
    • Export Citation
  • 23

    Tang JA, Scheer JK, Smith JS, et al. . The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2012;71(3):662669.

    • Search Google Scholar
    • Export Citation
  • 24

    Le Huec JC, Demezon H, Aunoble S. Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J. 2015;24(1):6371.

    • Search Google Scholar
    • Export Citation
  • 25

    Ward MM, Learch TJ, Gensler LS, et al. . Regional radiographic damage and functional limitations in patients with ankylosing spondylitis: differences in early and late disease. Arthritis Care Res (Hoboken). 2013;65(2):257265.

    • Search Google Scholar
    • Export Citation
  • 26

    Oh T, Scheer JK, Eastlack R, et al. . Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up. J Neurosurg Spine. 2015;22(6):658665.

    • Search Google Scholar
    • Export Citation
  • 27

    Chien JT, Chen IH, Lin KH. Atlantoaxial rotatory dislocation with hypoglossal nerve palsy in a patient with ankylosing spondylitis. A case report. J Bone Joint Surg Am. 2005;87(7):15871590.

    • Search Google Scholar
    • Export Citation
  • 28

    Robinson Y, Robinson AL, Olerud C. Complications and survival after long posterior instrumentation of cervical and cervicothoracic fractures related to ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis. Spine (Phila Pa 1976).2015;40(4):E227E233.

    • Search Google Scholar
    • Export Citation
  • 29

    Sengupta DK, Khazim R, Grevitt MP, Webb JK. Flexion osteotomy of the cervical spine: a new technique for correction of iatrogenic extension deformity in ankylosing spondylitis. Spine (Phila Pa 1976).2001;26(9):10681072.

    • Search Google Scholar
    • Export Citation

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