Zhuo-Jie Liu1, Bang-Ping Qian2, Yong Qiu3, Sai-Hu Mao4, Jun Jiang5, Bin Wang6. 1. The Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: 442571964@qq.com. 2. The Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: qianbangping@163.com. 3. The Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: scoliosis2002@sina.com. 4. The Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: siemens_636@163.com. 5. The Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: spine821107@163.com. 6. The Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China. Electronic address: bingwangtougao@163.com.
Abstract
OBJECTIVE: To investigate if pelvic incidence (PI) and lumbar lordosis (LL) mismatching affects surgical outcomes for ankylosing spondylitis (AS) related kyphosis following 1-level lumbar pedicle subtraction osteotomy (PSO). PATIENTS AND METHODS: AS patients with thoracolumbar kyphosis, who underwent 1-level lumbar PSO from March 2006 and February 2014 in our institution, were retrospectively reviewed. The radiographic measurements and health-related quality of life (HRQoL) scores, including Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for pain, were recorded at baseline and the last follow-up. Patients were divided into 2 groups according to PI-LL matching or not postoperatively (Match Group, Mismatch Group), and comparison of the aforementioned parameters between the two groups was performed. RESULTS: Seventy patients were enrolled with a mean age of 34.60 ± 9.45 years (range, 17 yrs.-59 yrs.). Among them, 44 were included in the Match Group and 26 in the Mismatch Group. At baseline, patients in the Match Group had larger LL (p = 0.014) and smaller pelvic tilt (PT, p < 0.001) than patients in the Mismatch Group. At the last follow-up, along with larger LL (p = 0.004) and smaller PT (p = 0.001), Match Group patients also had significantly smaller sagittal vertical axis (SVA, 3.31 cm vs 6.27 cm, p = 0.001) than those in the Mismatch Group. Seventy-five percent (33/44) of the patients in the Match Group had a SVA < 5 cm at the last follow-up, while in the Mismatch Group, only 35% (9/26) of the patients did. However, no significant difference was found between the two groups regarding HRQoL scores. CONCLUSION: Patients with postoperative PI-LL matching were more likely to have a better correction of SVA; they also tended to have a smaller preoperative PT. However, PI-LL mismatching didn't affect HRQoL scores at the last follow-up, which was different from the results of previous studies in the settings of ASD.
OBJECTIVE: To investigate if pelvic incidence (PI) and lumbar lordosis (LL) mismatching affects surgical outcomes for ankylosing spondylitis (AS) related kyphosis following 1-level lumbar pedicle subtraction osteotomy (PSO). PATIENTS AND METHODS: AS patients with thoracolumbar kyphosis, who underwent 1-level lumbar PSO from March 2006 and February 2014 in our institution, were retrospectively reviewed. The radiographic measurements and health-related quality of life (HRQoL) scores, including Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for pain, were recorded at baseline and the last follow-up. Patients were divided into 2 groups according to PI-LL matching or not postoperatively (Match Group, Mismatch Group), and comparison of the aforementioned parameters between the two groups was performed. RESULTS: Seventy patients were enrolled with a mean age of 34.60 ± 9.45 years (range, 17 yrs.-59 yrs.). Among them, 44 were included in the Match Group and 26 in the Mismatch Group. At baseline, patients in the Match Group had larger LL (p = 0.014) and smaller pelvic tilt (PT, p < 0.001) than patients in the Mismatch Group. At the last follow-up, along with larger LL (p = 0.004) and smaller PT (p = 0.001), Match Group patients also had significantly smaller sagittal vertical axis (SVA, 3.31 cm vs 6.27 cm, p = 0.001) than those in the Mismatch Group. Seventy-five percent (33/44) of the patients in the Match Group had a SVA < 5 cm at the last follow-up, while in the Mismatch Group, only 35% (9/26) of the patients did. However, no significant difference was found between the two groups regarding HRQoL scores. CONCLUSION:Patients with postoperative PI-LL matching were more likely to have a better correction of SVA; they also tended to have a smaller preoperative PT. However, PI-LL mismatching didn't affect HRQoL scores at the last follow-up, which was different from the results of previous studies in the settings of ASD.
Keywords:
Ankylosing spondylitis; Health related quality of life; Sagittal alignment; Spino-pelvic parameters; Surgery planning; Thoracolumbar kyphosis