A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis

Background Data: Ankylosing spondylitis (AS) is a chronic inflammatory disease that can severely alter the normal spinal sagittal balance resulting in functional and social disability. Although the traditional open corrective techniques have provided a great radiographic improvement, they are associ...

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Autores principales:	Mahmoud Fouad Ibrahim, MD, Mohamed El-Meshtawy, MD, Mootaz Shousha,* MD, Heinrich Boehm*, MD
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2018
Materias:	ankylosing spondylitis; minimally invasive spine surgery; sagittal imbalance Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/98ce229bbb6d4885b3b0348d71f86dc1
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spelling	oai:doaj.org-article:98ce229bbb6d4885b3b0348d71f86dc12021-12-02T04:30:05ZA Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis10.21608/esj.2018.182902314-89692314-8950https://doaj.org/article/98ce229bbb6d4885b3b0348d71f86dc12018-07-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_18290.htmlhttps://doaj.org/toc/2314-8969https://doaj.org/toc/2314-8950Background Data: Ankylosing spondylitis (AS) is a chronic inflammatory disease that can severely alter the normal spinal sagittal balance resulting in functional and social disability. Although the traditional open corrective techniques have provided a great radiographic improvement, they are associated with relatively high morbidity and mortality in an already vulnerable patient with several medical comorbidities. Therefore, a new less invasive technique has been developed in an attempt to achieve both radiographic and clinical improvement while minimizing the possible surgical risks of conventional open approaches. Purpose: To present an innovative less invasive technique for management of thoracic and/or lumbar sagittal imbalance in AS and to evaluate the morbidity, clinical results and radiographic correction following the use of this technique. Study design: Retrospective analysis of prospectively collected data. Methods: Between September 2008 and September 2013, 51 patients (43 males and 8 females) with thoracic and/or lumbar sagittal imbalance due to AS were operated upon. Those patients underwent minimally invasive dorso-ventral osteotomy and reconstruction plus posterior percutaneous instrumentation in the same prone position. Sagittal vertical axis (SVA), T1 pelvic angle (TPA), angle of fusion levels (AFL) and chin-brow vertical angle (CBVA) were used to evaluate radiographic outcomes and degree of correction. Clinical outcomes were assessed by Oswestry Disability Index (ODI) and visual analogue scale (VAS). Results: The mean age at operation was 49.02 years. The mean operative time was 419.31 min with a mean blood loss of 698.24 ml. One third of the patients underwent more than one single dorso-ventral osteotomy. All clinical and radiographic parameters (except for PI) showed a statistically significant improvement after surgery (P< 0.0001). The mean correction of AFL was 32.23±10.16° while the mean loss of correction was 2.00±2.89°. In the present study, not only the mean ODI improved significantly from 48.67±7.86 preoperatively to 19.25±10.22 at the latest follow up (P< 0.0001), but also 94% of the patients showed >30% improvement from the baseline ODI. Moreover, the changes in ODI were significantly related to the changes in SVA, TPA, AFL and CBVA. Dural tear and transient radiculopathy were the most common complications. Conclusion: This technique has obvious advantages in reducing blood loss, optimizing correction and reconstruction, facilitating the postoperative course, and providing satisfactory clinical outcomes. We believe that this novel technique, although technically demanding, offers a safe and effective alternative for traditional open surgery in managing thoracic and/or lumbar sagittal imbalance due to AS. (2018ESJ159) Mahmoud Fouad Ibrahim, MD Mohamed El-Meshtawy, MDMootaz Shousha,* MD Heinrich Boehm*, MDEgyptian Spine Associationarticleankylosing spondylitis; minimally invasive spine surgery; sagittal imbalanceNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 27, Iss 1, Pp 16-28 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	ankylosing spondylitis; minimally invasive spine surgery; sagittal imbalance Neurology. Diseases of the nervous system RC346-429
spellingShingle	ankylosing spondylitis; minimally invasive spine surgery; sagittal imbalance Neurology. Diseases of the nervous system RC346-429 Mahmoud Fouad Ibrahim, MD Mohamed El-Meshtawy, MD Mootaz Shousha,* MD Heinrich Boehm*, MD A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis
description	Background Data: Ankylosing spondylitis (AS) is a chronic inflammatory disease that can severely alter the normal spinal sagittal balance resulting in functional and social disability. Although the traditional open corrective techniques have provided a great radiographic improvement, they are associated with relatively high morbidity and mortality in an already vulnerable patient with several medical comorbidities. Therefore, a new less invasive technique has been developed in an attempt to achieve both radiographic and clinical improvement while minimizing the possible surgical risks of conventional open approaches. Purpose: To present an innovative less invasive technique for management of thoracic and/or lumbar sagittal imbalance in AS and to evaluate the morbidity, clinical results and radiographic correction following the use of this technique. Study design: Retrospective analysis of prospectively collected data. Methods: Between September 2008 and September 2013, 51 patients (43 males and 8 females) with thoracic and/or lumbar sagittal imbalance due to AS were operated upon. Those patients underwent minimally invasive dorso-ventral osteotomy and reconstruction plus posterior percutaneous instrumentation in the same prone position. Sagittal vertical axis (SVA), T1 pelvic angle (TPA), angle of fusion levels (AFL) and chin-brow vertical angle (CBVA) were used to evaluate radiographic outcomes and degree of correction. Clinical outcomes were assessed by Oswestry Disability Index (ODI) and visual analogue scale (VAS). Results: The mean age at operation was 49.02 years. The mean operative time was 419.31 min with a mean blood loss of 698.24 ml. One third of the patients underwent more than one single dorso-ventral osteotomy. All clinical and radiographic parameters (except for PI) showed a statistically significant improvement after surgery (P< 0.0001). The mean correction of AFL was 32.23±10.16° while the mean loss of correction was 2.00±2.89°. In the present study, not only the mean ODI improved significantly from 48.67±7.86 preoperatively to 19.25±10.22 at the latest follow up (P< 0.0001), but also 94% of the patients showed >30% improvement from the baseline ODI. Moreover, the changes in ODI were significantly related to the changes in SVA, TPA, AFL and CBVA. Dural tear and transient radiculopathy were the most common complications. Conclusion: This technique has obvious advantages in reducing blood loss, optimizing correction and reconstruction, facilitating the postoperative course, and providing satisfactory clinical outcomes. We believe that this novel technique, although technically demanding, offers a safe and effective alternative for traditional open surgery in managing thoracic and/or lumbar sagittal imbalance due to AS. (2018ESJ159)
format	article
author	Mahmoud Fouad Ibrahim, MD Mohamed El-Meshtawy, MD Mootaz Shousha,* MD Heinrich Boehm*, MD
author_facet	Mahmoud Fouad Ibrahim, MD Mohamed El-Meshtawy, MD Mootaz Shousha,* MD Heinrich Boehm*, MD
author_sort	Mahmoud Fouad Ibrahim, MD
title	A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis
title_short	A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis
title_full	A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis
title_fullStr	A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis
title_full_unstemmed	A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis
title_sort	less invasive technique for correction of thoracolumbar sagittal deformity in ankylosing spondylitis
publisher	Egyptian Spine Association
publishDate	2018
url	https://doaj.org/article/98ce229bbb6d4885b3b0348d71f86dc1
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A Less Invasive Technique for Correction of Thoracolumbar Sagittal Deformity in Ankylosing Spondylitis

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