Clinical Outcome and Complications of Transpedicular Closing-wedge Osteotomy for Correction of Deformity in Ankylosing Spondylitis in a Regional Hospital

Abstract

Study design Prospective study of surgical correction of thoracolumbar kyphotic deformity caused by ankylosing spondylitis. Objectives To assess surgical outcomes and complications of thoracolumbar kyphotic deformity corrected with transpedicular closing-wedge osteotomy performed in a regional hospital. Summary of background data There have been several studies reporting on the results of surgical correction of deformity in ankylosing spondylitis all over the world. However, there has not been any local data published. Methods From 2003 to 2011, we had performed 12 transpedicular closing-wedge osteotomies in 9 patients with ankylosing spondylitis for correction of kyphotic and scoliotic deformity in thoracolumbar spine. Operative outcomes were assessed clinically by recording the Japanese Orthopaedic Association (JOA) scores, visual analogue scale (VAS) pain scores, Oswestry Disability Index (ODI) preoperatively and postoperatively and patient satisfaction postoperatively. Radiological outcome was assessed by measuring thoracic kyphosis, lumbar lordosis and sagittal plumb line preoperatively and postoperatively as well as the degree of surgical correction. Occurrence of complications was recorded by our standard audit protocol. Results All patients had a single level of osteotomy done at a time. Most of the osteotomies were done at L2 or L3. The mean amount of correction was 21.6°. Complications included dural tear, pseudoarthrosis and transient radiculopathy. The extent of correction and incidence of complications improved with experience. Conclusion Despite transpedicular closing-wedge osteotomy being a major operation that is not without complications, most of our patients had good clinical results and subjective satisfaction.