Review
Lumbar osteotomy for correction of thoracolumbar
kyphotic deformity in ankylosing spondylitis. A structured review
of three methods of treatment
B J Van Royen, A De Gast
Department of
Orthopaedic Surgery, Free University Hospital, De Boelelaan 1117 1081 HV Amsterdam, the Netherlands
Correspondence to: Dr B J Van Royen.
Accepted for publication 18 March 1999
OBJECTIVES
Three
operative techniques have been described to correct thoracolumbar
kyphotic deformity (TLKD) resulting from ankylosing spondylitis (AS) at
the level of the lumbar spine: opening wedge osteotomy, polysegmental
wedge osteotomies, and closing wedge osteotomy. Little knowledge exists
on the indication for, and outcome of these corrective lumbar osteotomies.
METHODS
A structured
review of the medical literature was performed.
RESULTS
A search of
the literature revealed 856 patients reported in 41 articles published
between 1945 and 1998. The mean age at time of operation was 41 years,
male-female ratio 7.5 to 1. In 451 patients an open wedge osteotomy was
performed. Polysegmental wedge osteotomies were performed in 249 patients and a closing wedge osteotomy in 156 patients. Most of the
studies primarily focus on the surgical technique. Technical outcome
data were poorly reported. Sixteen reports, including 523 patients, met
the inclusion criteria of this study, and could be analysed for
technical outcome data. The average correction achieved with each
surgical techniques ranged from 37 to 40 degrees. Loss of correction
was mainly reported in patients treated by open wedge osteotomy and
polysegmental wedge osteotomies. Neurological complications were
reported in all three techniques. The perioperative mortality was 4%.
Pulmonary, cardiac and intestinal problems were found to be the major
cause of fatal complications.
CONCLUSION
Lumbar
osteotomy for correction of TLKD resulting from AS is a major surgery.
The indication for these lumbar osteotomies as well as the degree of
correction in the lumbar spine has not yet been established.
Furthermore, there is a need for a generally accepted clinical score
that encompasses accurate preoperative and postoperative assessment of
the spinal deformity. The results of this review suggest that the data
from the literature are not suitable for decision making with regard to
surgical treatment of TLKD resulting from AS.
© 1999 by Annals of the Rheumatic Diseases
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