The aim of this study was to investigate time-dependent rates and indications of unplanned reoperation and to evaluate the most common indication depending on the time interval after pedicle subtraction osteotomy (PSO) for correction of thoracolumbar kyphosis in patients with ankylosing spondylitis (AS).
开云体育世界杯赔率
A total of 321 consecutive patients with AS (284 men; mean age 43.8 years) with thoracolumbar kyphosis who underwent PSO were included. Patients who underwent reoperation after the index surgery were divided according to the duration of the follow-up period.
RESULTS
A total of 51 patients (15.9%) underwent unplanned reoperations. The reoperation groups had greater preoperative and postoperative C7 sagittal vertical axis (SVA), and less lordotic postoperative osteotomy angle (−4.3° ± 18.6° vs −15.0° ± 13.7°, p < 0.001). The perioperative change in SVA was not significantly different between groups (−10.0 ± 7.1 cm vs −10.0 ± 5.1 cm, p = 0.970), while that in the osteotomy angle was significantly different (−22.4° ± 21.3° vs −30.0° ± 11.5°, p = 0.014). Most reoperations (45.1%; 23/51) were performed within 2 weeks of the initial operation. Within 2 weeks, the most common cause of reoperation was neurological deficit in 10 patients, with a cumulative reoperation rate of 3.2%. After 3 years, the most common complications were mechanical complications in 8 patients, accounting for 15.7% (8/51) of patients. Overall, the most common indications for reoperation were mechanical complications (17 patients; 5.3%), followed by neurological deficits (12 patients; 3.7%).
CONCLUSIONS
PSO may be the most effective surgical procedure for the correction of thoracolumbar kyphosis in patients with AS. However, 51 patients (15.9%) required an unplanned reoperation.
KimKT,SukKS,ChoYJ,HongGP,ParkBJ.Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity.Spine (Phila Pa 1976).2002;27(6):612–618.
Kim
KT
,
Suk
KS
,
Cho
YJ
,
Hong
GP
,
Park
BJ
.
Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity
.Spine (Phila Pa 1976)
.
2002
;
27
(
6
):
612
–
618
.
11884909)| false
SmithJS,SansurCA,DonaldsonWFIII,et al.Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee.Spine (Phila Pa 1976).2011;36(12):958–964.
Smith
JS
,
Sansur
CA
,
Donaldson
WF
III
,
Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee
.Spine (Phila Pa 1976)
.
2011
;
36
(
12
):
958
–
964
.
21192289)| false
RavinskyRA,OuelletJA,BrodtED,DettoriJR.Vertebral osteotomies in ankylosing spondylitis-comparison of outcomes following closing wedge osteotomy versus opening wedge osteotomy: a systematic review.Evid Based Spine Care J.2013;4(1):18–29.
Ravinsky
RA
,
Ouellet
JA
,
Brodt
ED
,
Dettori
JR
.
Vertebral osteotomies in ankylosing spondylitis-comparison of outcomes following closing wedge osteotomy versus opening wedge osteotomy: a systematic review
.Evid Based Spine Care J
.
2013
;
4
(
1
):
18
–
29
.
24436696)| false
WillemsKF,SlotGH,AndersonPG,PavlovPW,de KleuverM.Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year.Spine (Phila Pa 1976).2005;30(1):101–107.
Willems
KF
,
Slot
GH
,
Anderson
PG
,
Pavlov
PW
,
de Kleuver
M
.
Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year
.Spine (Phila Pa 1976)
.
2005
;
30
(
1
):
101
–
107
.
15626989)| false
FerreroE,LiabaudB,HenryJK,et al.Sagittal alignment and complications following lumbar 3-column osteotomy: does the level of resection matter?.J Neurosurg Spine.2017;27(5):560–569.
Ferrero
E
,
Liabaud
B
,
Henry
JK
,
Sagittal alignment and complications following lumbar 3-column osteotomy: does the level of resection matter?
.J Neurosurg Spine
.
2017
;
27
(
5
):
560
–
569
.
28885128)| false
KimYJ,BridwellKH,LenkeLG,ChehG,BaldusC.Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study.Spine (Phila Pa 1976).2007;32(20):2189–2197.
MaierSP,SmithJS,SchwabFJ,et al.Revision surgery after 3-column osteotomy in 335 patients with adult spinal deformity: intercenter variability and risk factors.Spine (Phila Pa 1976).2014;39(11):881–885.
LeeKH,KimKT,KimYC,LeeJW,HaKY.Radiographic findings for surgery-related complications after pedicle subtraction osteotomy for thoracolumbar kyphosis in 230 patients with ankylosing spondylitis.J Neurosurg Spine.2020;33(3):366–372.
Lee
KH
,
Kim
KT
,
Kim
YC
,
Lee
JW
,
Ha
KY
.
Radiographic findings for surgery-related complications after pedicle subtraction osteotomy for thoracolumbar kyphosis in 230 patients with ankylosing spondylitis
.J Neurosurg Spine
.
2020
;
33
(
3
):
366
–
372
.)| false
GlattesRC,BridwellKH,LenkeLG,KimYJ,RinellaA,EdwardsCII.Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis.Spine (Phila Pa 1976).2005;30(14):1643–1649.
SchwabF,PatelA,UngarB,FarcyJP,LafageV.Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery.Spine (Phila Pa 1976).2010;35(25):2224–2231.
Schwab
F
,
Patel
A
,
Ungar
B
,
Farcy
JP
,
Lafage
V
.
Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery
.Spine (Phila Pa 1976)
.
2010
;
35
(
25
):
2224
–
2231
.
21102297)| false
PassiasPG,Vasquez-MontesD,PoormanGW,et al.Predictive model for distal junctional kyphosis after cervical deformity surgery.Spine J.2018;18(12):2187–2194.
AuerbachJD,LenkeLG,BridwellKH,et al.Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures.Spine (Phila Pa 1976).2012;37(14):1198–1210.
BuchowskiJM,BridwellKH,LenkeLG,et al.Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment.Spine (Phila Pa 1976).2007;32(20):2245–2252.
ParkJS,KimJ,JooIH,SimKD,ParkYS.Analysis of risk factors for sagittal translation after pedicle subtraction osteotomy in patients with ankylosing spondylitis.Spine J.2018;18(8):1356–1362.
QianBP,MaoSH,JiangJ,WangB,QiuY.Mechanisms, predisposing factors, and prognosis of intraoperative vertebral subluxation during pedicle subtraction osteotomy in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis.Spine (Phila Pa 1976).2017;42(16):E983–E990.
Qian
BP
,
Mao
SH
,
Jiang
J
,
Wang
B
,
Qiu
Y
.
Mechanisms, predisposing factors, and prognosis of intraoperative vertebral subluxation during pedicle subtraction osteotomy in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis
.Spine (Phila Pa 1976)
.
2017
;
42
(
16
):
E983
–
E990
.
28796721)| false
JoDJ,KimKT,LeeSH,ChoMG,SeoEM.The incidence and management of dural tears and cerebrospinal fluid leakage during corrective osteotomy for ankylosing spondylitis with kyphotic deformity.J Korean Neurosurg Soc.2015;58(1):60–64.
Jo
DJ
,
Kim
KT
,
Lee
SH
,
Cho
MG
,
Seo
EM
.
The incidence and management of dural tears and cerebrospinal fluid leakage during corrective osteotomy for ankylosing spondylitis with kyphotic deformity
.J Korean Neurosurg Soc
.
2015
;
58
(
1
):
60
–
64
.
26279815)| false
ZuckermanSL,LaiCS,ShenY,et al.Incidence and risk factors of iatrogenic coronal malalignment after adult spinal deformity surgery: a single-center experience.J Neurosurg Spine.2022;36(4):585–594.
Zuckerman
SL
,
Lai
CS
,
Shen
Y
,
Incidence and risk factors of iatrogenic coronal malalignment after adult spinal deformity surgery: a single-center experience
.J Neurosurg Spine
.
2022
;
36
(
4
):
585
–
594
.)| false
WangT,ZhaoY,LiangY,ZhangH,WangZ,WangY.风险因素analysis of proximal junctional kyphosis after posterior osteotomy in patients with ankylosing spondylitis.J Neurosurg Spine.2018;29(1):75–80.
Wang
T
,
Zhao
Y
,
Liang
Y
,
Zhang
H
,
Wang
Z
,
Wang
Y
.
风险因素analysis of proximal junctional kyphosis after posterior osteotomy in patients with ankylosing spondylitis
.J Neurosurg Spine
.
2018
;
29
(
1
):
75
–
80
.
29676671)| false
LazennecJY,SaillantG,SaidiK,et al.Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients.Eur Spine J.1997;6(4):222–232.
Lazennec
JY
,
Saillant
G
,
Saidi
K
,
Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients
.Eur Spine J
.
1997
;
6
(
4
):
222
–
232
.
9294745)| false
CrawfordCHIII,GlassmanSD,CarreonLY,et al.Prevalence and indications for unplanned reoperations following index surgery in the adult symptomatic lumbar scoliosis NIH-sponsored clinical trial.Spine Deform.2018;6(6):741–744.
