Application of self-designed adjustable operation frame in treatment of severe kyphosis secondary to ankylosing spondylitis with posterior osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Wei ,  YU Haiyang , WANG Hongliang , ZHAI Yunlei , DONG Lei , ZHENG Guohui , XU Wenqiang , ZHANG Xu

Department of Orthopaedic Surgery, Fuyang People’s Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236000, P.R.China;

Corresponding?author：

YU Haiyang, Email: fy.yhy@163.com

Keywords：

Self-designed adjustable operation frame; ankylosing spondylitis; kyphosis; posterior osteotomy

DOI：

10.7507/1002-1892.202003115

Video：

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Objective To introduce a self-designed adjustable operation frame and explore the feasibility and safety in the treatment of severe kyphosis secondary to ankylosing spondylitis with posterior osteotomy.Methods Between March 2016 and May 2018, 7 cases of severe kyphosis secondary to ankylosing spondylitis were treated with posterior osteotomy using self-designed adjustable operation frame with prone position. There were 5 males and 2 females with an average age of 49.4 years (range, 40-55 years). The disease duration was 10-21 years (mean, 16.7 years). The apical vertebrae of kyphosis were located at T₁₁ in 2 cases, T₁₂ in 1 case, L₁ in 1 case, and L₂ in 3 cases. Among the 7 cases, 2 were classified as typeⅠ, 4 as type ⅡB, and 1 as type ⅢA according to 301 classification system. There was no neurological deficit of all cases; but 1 case suffered bilateral hip joints ankylosed in non-functional position. The parameters of chin-brow vertical angle (CBVA), global kyphosis (GK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sagittal vertical axis (SVA) were measured; and the operation time, the intraoperative blood loss, and the complications were also collected and analyzed.Results All operations completed successfully. The operation time was 310-545 minutes (mean, 409.7 minutes) and the intraoperative blood loss was 1 500-2 500 mL (mean, 1 642.9 mL). There were 2 cases treated with one-level osteotomy of sagittal translation, 1 case of radiculopathy symptom of L₃, and 3 cases of tension of abdominal skin. All patients were followed up 20-35 months (mean, 27.9 months). There were significant differences in CBVA, GK, TLK, LL, and SVA between pre- and post-operation (P<0.05); but no significant difference between 1 week after operation and last follow-up (P>0.05). All the osteotomies and bone grafts fused well and no complications of loosening and breakage of internal fixator occurred during the follow-up.Conclusion In the posterior osteotomy for correction of severe kyphosis secondary to ankylosing spondylitis, the self-designed adjustable operation frame is convenient for the patient to be placed in prone position. It is safe, feasible, and effective to perform osteotomy correction with the aid of the self-designed adjustable operation frame.

Citation： ZHANG Wei, YU Haiyang, WANG Hongliang, ZHAI Yunlei, DONG Lei, ZHENG Guohui, XU Wenqiang, ZHANG Xu. Application of self-designed adjustable operation frame in treatment of severe kyphosis secondary to ankylosing spondylitis with posterior osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(10): 1269-1274. doi: 10.7507/1002-1892.202003115 Copy

1.	丁柯元, 朱金文, 陳浩, 等. 經后路椎弓根側方入路病灶清除聯合椎間植骨內固定術治療強直性脊柱炎合并胸腰段 Andersson 病損. 中國修復重建外科雜志, 2019, 33(12): 1474-1479.
2.	Zhong W, Chen Z, Zeng Y, et al. Two-level osteotomy for the corrective surgery of severe kyphosis from ankylosing spondylitis: A retrospective series. Spine (Phila Pa 1976), 2019, 44(23): 1638-1646.
3.	Wang T, Zheng G, Wang Y, et al. Comparison of 2 surgeries in correction of severe kyphotic deformity caused by ankylosing spondylitis: vertebral column decancellation and pedicle subtraction osteotomy. World Neurosurg, 2019, 127: e972-e978.
4.	Xin Z, Zheng G, Huang P, et al. Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients. J Orthop Surg Res, 2019, 14(1): 330.
5.	Graham RB, Cotton M, Koht A, et al. Loss of intraoperative neurological monitoring signals during flexed prone positioning on a hinged open frame during surgery for kyphoscoliosis correction: case report. J Neurosurg Spine, 2018, 29(3): 339-343.
6.	丁江平, 翁習生, 唐國柱, 等. 重度僵硬性脊柱畸形后路三柱截骨矯形 67 例療效及并發癥分析. 中國骨與關節雜志, 2020, 9(4): 246-254.
7.	Jin SJ, Park YS, Kim SH, et al. Effect of prone positional apparatus on the occurrence of acute kidney injury after spine surgery. World Neurosurg, 2019, 128: e597-e602.
8.	Messina A, Montagnini C, Cammarota G, et al. Complications associated with prone positioning in elective spinal surgery. Anesth Analg, 2020, 130(3): 752-761.
9.	Shlobin NA, Dahdaleh NS. Surgical stabilization of a cervical fracture in a patient with ankylosing spondylitis in the sitting position. Cureus, 2020, 12(1): e6625.
10.	徐輝, 張永剛, 毛克亞, 等. 經椎弓根截骨術治療強直性脊柱炎后凸畸形. 中國修復重建外科雜志, 2013, 27(4): 389-392.
11.	Rui L, Xu G, Lv X, et al. A comprehensive protocol to prevent brachial plexus injury during ankylosing spondylitis surgery. J Perianesth Nurs, 2018, 33(6): 908-914.
12.	李強, 陳濤, 周瑩, 等. 強直性脊柱炎極重度后凸畸形折疊人麻醉管理一例. 臨床麻醉學雜志, 2019, 35(3): 310-311.
13.	Qian BP, Huang JC, Qiu Y, et al. Complications of spinal osteotomy for thoracolumbar kyphosis secondary to ankylosing spondylitis in 342 patients: incidence and risk factors. J Neurosurg Spine, 2018, 30(1): 91-98.
14.	Wang Y, Xue C, Song K, et al. Comparison of loss of correction between PSO and VCD technique in treating thoracolumbar kyphosis secondary to ankylosing spondylitis, a minimum 2 years follow-up. J Orthop Surg Res, 2019, 14(1): 137.
15.	李長明, 趙士杰, 許建柱, 等. 經椎弓根楔形截骨聯合長節段椎弓根螺釘固定治療強直性脊柱炎后凸畸形合并胸腰段骨折的短期療效. 中華創傷雜志, 2019, 35(6): 501-507.
16.	Qian BP, Mao SH, Jiang J, et al. 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.
17.	Kolb B, Large J, Watson S, et al. An innovative prone positioning system for advanced deformity and frailty in complex spine surgery. J Neurosurg Spine, 2019, 32(2): 229-234.
18.	Park JS, Kim J, Joo IH, et al. Analysis of risk factors for sagittal translation after pedicle subtraction osteotomy in ankylosing spondylitis patients. Spine J, 2018, 18(8): 1356-1362.
19.	Chang KW, Chen HC, Chen YY, et al. Sagittal translation in opening wedge osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. Spine (Phila Pa 1976), 2006, 31(10): 1137-1142.
20.	Qian BP, Zhang YP, Qiao M, et al. Accuracy of freehand pedicle screw placement in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis: a computed tomography investigation of 2314 consecutive screws. World Neurosurg, 2018, (116): E850-E855.

1. 丁柯元, 朱金文, 陳浩, 等. 經后路椎弓根側方入路病灶清除聯合椎間植骨內固定術治療強直性脊柱炎合并胸腰段 Andersson 病損. 中國修復重建外科雜志, 2019, 33(12): 1474-1479.
2. Zhong W, Chen Z, Zeng Y, et al. Two-level osteotomy for the corrective surgery of severe kyphosis from ankylosing spondylitis: A retrospective series. Spine (Phila Pa 1976), 2019, 44(23): 1638-1646.
3. Wang T, Zheng G, Wang Y, et al. Comparison of 2 surgeries in correction of severe kyphotic deformity caused by ankylosing spondylitis: vertebral column decancellation and pedicle subtraction osteotomy. World Neurosurg, 2019, 127: e972-e978.
4. Xin Z, Zheng G, Huang P, et al. Clinical results and surgery tactics of spinal osteotomy for ankylosing spondylitis kyphosis: experience of 428 patients. J Orthop Surg Res, 2019, 14(1): 330.
5. Graham RB, Cotton M, Koht A, et al. Loss of intraoperative neurological monitoring signals during flexed prone positioning on a hinged open frame during surgery for kyphoscoliosis correction: case report. J Neurosurg Spine, 2018, 29(3): 339-343.
6. 丁江平, 翁習生, 唐國柱, 等. 重度僵硬性脊柱畸形后路三柱截骨矯形 67 例療效及并發癥分析. 中國骨與關節雜志, 2020, 9(4): 246-254.
7. Jin SJ, Park YS, Kim SH, et al. Effect of prone positional apparatus on the occurrence of acute kidney injury after spine surgery. World Neurosurg, 2019, 128: e597-e602.
8. Messina A, Montagnini C, Cammarota G, et al. Complications associated with prone positioning in elective spinal surgery. Anesth Analg, 2020, 130(3): 752-761.
9. Shlobin NA, Dahdaleh NS. Surgical stabilization of a cervical fracture in a patient with ankylosing spondylitis in the sitting position. Cureus, 2020, 12(1): e6625.
10. 徐輝, 張永剛, 毛克亞, 等. 經椎弓根截骨術治療強直性脊柱炎后凸畸形. 中國修復重建外科雜志, 2013, 27(4): 389-392.
11. Rui L, Xu G, Lv X, et al. A comprehensive protocol to prevent brachial plexus injury during ankylosing spondylitis surgery. J Perianesth Nurs, 2018, 33(6): 908-914.
12. 李強, 陳濤, 周瑩, 等. 強直性脊柱炎極重度后凸畸形折疊人麻醉管理一例. 臨床麻醉學雜志, 2019, 35(3): 310-311.
13. Qian BP, Huang JC, Qiu Y, et al. Complications of spinal osteotomy for thoracolumbar kyphosis secondary to ankylosing spondylitis in 342 patients: incidence and risk factors. J Neurosurg Spine, 2018, 30(1): 91-98.
14. Wang Y, Xue C, Song K, et al. Comparison of loss of correction between PSO and VCD technique in treating thoracolumbar kyphosis secondary to ankylosing spondylitis, a minimum 2 years follow-up. J Orthop Surg Res, 2019, 14(1): 137.
15. 李長明, 趙士杰, 許建柱, 等. 經椎弓根楔形截骨聯合長節段椎弓根螺釘固定治療強直性脊柱炎后凸畸形合并胸腰段骨折的短期療效. 中華創傷雜志, 2019, 35(6): 501-507.
16. Qian BP, Mao SH, Jiang J, et al. 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.
17. Kolb B, Large J, Watson S, et al. An innovative prone positioning system for advanced deformity and frailty in complex spine surgery. J Neurosurg Spine, 2019, 32(2): 229-234.
18. Park JS, Kim J, Joo IH, et al. Analysis of risk factors for sagittal translation after pedicle subtraction osteotomy in ankylosing spondylitis patients. Spine J, 2018, 18(8): 1356-1362.
19. Chang KW, Chen HC, Chen YY, et al. Sagittal translation in opening wedge osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. Spine (Phila Pa 1976), 2006, 31(10): 1137-1142.
20. Qian BP, Zhang YP, Qiao M, et al. Accuracy of freehand pedicle screw placement in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis: a computed tomography investigation of 2314 consecutive screws. World Neurosurg, 2018, (116): E850-E855.

Chinese Journal of Reparative and Reconstructive Surgery

Application of self-designed adjustable operation frame in treatment of severe kyphosis secondary to ankylosing spondylitis with posterior osteotomy

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