Download PDF
Die Wirbelsäule 2018; 02(04): 279-289
DOI: 10.1055/a-0641-2182
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Aktuelle operative Therapiekonzepte zur Behandlung von Wirbelsäulendeformitäten bei Morbus Bechterew

Current concepts in the surgical management of spinal deformities in ankylosing spondylitis
J. Bogert
Werner-Wicker-Klinik, Bad Wildungen
,
H. Koller
Werner-Wicker-Klinik, Bad Wildungen
,
A. Tateen
Werner-Wicker-Klinik, Bad Wildungen
,
A. Hempfing
Werner-Wicker-Klinik, Bad Wildungen
› Author Affiliations
Further Information

Publication History

Publication Date:
13 November 2018 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Korrektur von Wirbelsäulendeformitäten beim M. Bechterew erfordert eine große operative Erfahrung. Ist die OP-Indikation bei Absenkung der Blickachse und damit verbundener Einschränkung der Lebensqualität recht klar zu stellen, so erfordert die OP-Planung eine sorgfältige Beurteilung der individuellen Anatomie und des sagittalen Profils. Durch die präoperative Analyse wird, neben dem notwendigen Korrekturausmaß, insbesondere die Lokalisation und die Art der Osteotomie festgelegt. Über die eigentliche Osteotomie hinaus ist die Technik der implantatgeführten Korrektur von entscheidender Bedeutung, um Komplikationen wie eine Translation zu vermeiden. Die vorliegende Übersichtsarbeit fasst das aktuelle Vorgehen von Planung und operativer Korrektur zusammen.

Abstract

The correction of spinal deformities in patients with ankylosing spondylitis demands extensive experience. The indication for surgery due to the loss of horizontal visual axis and the reduction in quality of life is clear, but surgical planning requires accurate assessment of individual anatomy and sagittal profile. Among preoperative planning the ideal amount of correction as well as localisation and type of osteotomy have to be determined. Besides the technique of osteotomy, the technique of implant guided correction is of great importance to avoid complications such as sudden vertebral subluxation and translation. This overview summarises the actual process of planning and surgical correction.

Schlüsselwörter

M. Bechterew - Sagittalprofil - operative Korrekturplanung - Osteotomien

Keywords

ankylosing spondylitis - sagittal profile - surgical planning - osteotomies
 

  • Literatur

  • 1 Sabou S, Mehdian H, Pasku D. et al. Health-related quality of life in patients undergoing cervico-thoracic osteotomies for fixed cervico-thoracic kyphosis in patients with ankylosing spondylitis. Eur Spine J 2018; 27: 1586-1592
    CrossrefGoogle Scholar
  • 2 Song K, Su X, Zhang Y. et al. Optimal chin-brow vertical angle for sagittal visual fields in ankylosing spondylitis kyphosis. Eur Spine J 2016; 25: 2596-2604
    CrossrefGoogle Scholar
  • 3 Patwardhan AG, Havey RM, Khayatzadeh S. et al. Postural consequences of cervical sagittal imbalance: A novel laboratory model. Spine (Phila Pa 1976) 2015; 40: 783-792
    CrossrefGoogle Scholar
  • 4 Theologis AA, Tabaraee E, Funao H. et al. Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients. Eur Spine J 2015; 24 (Suppl. 01) S23-30
    CrossrefGoogle Scholar
  • 5 Ames CP, Smith JS, Eastlack R. et al. Reliability assessment of a novel cervical spine deformity classification system. J Neurosurg Spine 2015; 23: 673-683
    CrossrefPubMedGoogle Scholar
  • 6 Van Royen BJ, De Gast A, Smit TH. Deformity planning for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Eur Spine J 2000; 9: 492-498
    CrossrefGoogle Scholar
  • 7 Camargo FP, Cordeiro EN, Napoli MM. Corrective osteotomy of the spine in ankylosing spondylitis. Experience with 66 cases. Clin Orthop Relat Res 1986; 208: 157-167
    Google Scholar
  • 8 Lafage V, Schwab F, Vira S. et al. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?. J Neurosurg Spine 2011; 14: 184-191
    CrossrefPubMedGoogle Scholar
  • 9 Pigge RR, Scheerder FJ, Smit TH. et al. Effectiveness of preoperative planning in the restoration of balance and view in ankylosing spondylitis. Neurosurg Focus 2008; 24: E7
    CrossrefPubMedGoogle Scholar
  • 10 Scudese VA, Calabro JJ. Vertebral wedge osteotomy. Correction of rheumatoid (ankylosing) apondylitis. JAMA 1963; 186: 627-631
    CrossrefGoogle Scholar
  • 11 Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res 1985; 194: 142-152
    Google Scholar
  • 12 Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 1969; 66: 6-9
    Google Scholar
  • 13 Mason C, Cozen L, Adelstein L. Surgical correction of flexion deformity of the cervical spine. Calif Med 1953; 79: 244-246
    Google Scholar
  • 14 Koller H, Meier O, Zenner J. et al. Non-instrumented correction of cervicothoracic kyphosis in ankylosing spondylitis: a critical analysis on the results of open-wedge osteotomy C7-T1 with gradual Halo-Thoracic-Cast based correction. Eur Spine J 2013; 22: 819-832
    CrossrefGoogle Scholar
  • 15 Schwab F, Blondel B, Chay E. et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery 2015; 76 (Suppl. 01) S33-41 ; discussion S41
    CrossrefGoogle Scholar
  • 16 Ames CP, Smith JS, Scheer JK. et al. A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article. J Neurosurg Spine 2013; 19: 269-278
    CrossrefGoogle Scholar
  • 17 Koller H, Koller J, Mayer M. et al. Osteotomies in ankylosing spondylitis: where, how many, and how much?. Eur Spine J 2018; 27: 70-100
    CrossrefPubMedGoogle Scholar
  • 18 Chang KW, Chen YY, Lin CC. et al. Closing wedge osteotomy versus opening wedge osteotomy in ankylosing spondylitis with thoracolumbar kyphotic deformity. Spine (Phila Pa 1976) 2005; 30: 1584-1593
    CrossrefGoogle Scholar
  • 19 Allouch H, Shousha M, Bohm H. [Surgical management of ankylosing spondylitis (Bechterew's disease)]. Z Rheumatol 2017; 76: 848-859
    CrossrefGoogle Scholar
  • 20 Böhm H, Hehne HJ, Zielke K. [Correction of Bechterew kyphosis]. Orthopäde 1989; 18: 142-154
    Google Scholar
  • 21 Qian BP, Wang XH, Qiu Y. et al. The influence of closing-opening wedge osteotomy on sagittal balance in thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison with closing wedge osteotomy. Spine (Phila Pa 1976) 2012; 37: 1415-1423
    CrossrefGoogle Scholar
  • 22 Zhang X, Zhang Z, Wang J. et al. Vertebral column decancellation: a new spinal osteotomy technique for correcting rigid thoracolumbar kyphosis in patients with ankylosing spondylitis. Bone Joint J 2016; 98-B: 672-678
    CrossrefGoogle Scholar
  • 23 Van Royen BJ, De Gast A. Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis 1999; 58: 399-406
    CrossrefGoogle Scholar
  • 24 Arun R, Dabke HV, Mehdian H. Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction. Eur Spine J 2011; 20: 2252-2260
    CrossrefGoogle Scholar
  • 25 Hu X, Thapa AJ, Cai Z. et al. Comparison of smith-petersen osteotomy, pedicular subtraction osteotomy, and poly-segmental wedge osteotomy in treating rigid thoracolumbar kyphotic deformity in ankylosing spondylitis a systematic review and meta-analysis. BMC Surg 2016; 16: 4
    CrossrefGoogle Scholar
  • 26 Zheng G, Song K, Yao Z. et al. How to calculate the exact angle for two-level osteotomy in ankylosing spondylitis?. Spine (Phila Pa 1976) 2016; 41: E1046-1052
    CrossrefGoogle Scholar
  • 27 Atici Y, Akman YE, Balioglu MB. et al. Two level pedicle substraction osteotomies for the treatment of severe fixed sagittal plane deformity: computer software-assisted preoperative planning and assessing. Eur Spine J 2016; 25: 2461-2470
    CrossrefGoogle Scholar
  • 28 Hua WB, Zhang YK, Gao Y. et al. Analysis of sagittal parameters in patients undergoing one- or two-level closing wedge osteotomy for correcting thoracolumbar kyphosis secondary to ankylosing spondylitis. Spine (Phila Pa 1976) 2017; 42: E848-E854
    CrossrefGoogle Scholar
  • 29 Mehdian S, Arun R. A safe controlled instrumented reduction technique for cervical osteotomy in ankylosing spondylitis. Spine (Phila Pa 1976) 2011; 36: 715-720
    CrossrefGoogle Scholar
  • 30 Deviren V, Scheer JK, Ames CP. Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases. J Neurosurg Spine 2011; 15: 174-181
    CrossrefGoogle Scholar
  • 31 Kim HJ, Piyaskulkaew C, Riew KD. Comparison of Smith-Petersen osteotomy versus pedicle subtraction osteotomy versus anterior-posterior osteotomy types for the correction of cervical spine deformities. Spine (Phila Pa 1976) 2015; 40: 143-146
    CrossrefGoogle Scholar
  • 32 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: E983-E990
    CrossrefGoogle Scholar
  • 33 Lee SH, Kim KT, Suk KS. et al. A sterile-freehand reduction technique for corrective osteotomy of fixed cervical kyphosis. Spine (Phila Pa 1976) 2012; 37: 2145-2150
    CrossrefGoogle Scholar
  • 34 Ji ML, Qian BP, Qiu Y. et al. Change in abdominal morphology after surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis: A computed tomographic study. Spine (Phila Pa 1976) 2015; 40: E1244-1249
    CrossrefGoogle Scholar
  • 35 Liu H, Yang C, Zheng Z. et al. Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis. Spine (Phila Pa 1976) 2015; 40: 570-579
    CrossrefPubMedGoogle Scholar
  • 36 Mundwiler ML, Siddique K, Dym JM. et al. Complications of the spine in ankylosing spondylitis with a focus on deformity correction. Neurosurg Focus 2008; 24: E6
    CrossrefPubMedGoogle Scholar
  • 37 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: 1137-1142
    CrossrefGoogle Scholar
  • 38 Park JS, Kim J, Joo IH. et al. Analysis of risk factors for sagittal translation after pedicle subtraction osteotomy in patients with ankylosing spondylitis. Spine J 2018; DOI: 10.1016/j.spinee.2017.12.006. , epub ahead of print
    Google Scholar
  • 39 Sciubba DM, Nelson C, Hsieh P. et al. Perioperative challenges in the surgical management of ankylosing spondylitis. Neurosurg Focus 2008; 24: E10
    Google Scholar