Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients
| Autor: | K. Saidi, R. Roy-Camille, N. Arafati, Jean Yves Lazennec, Benazet Jp, Gérard Saillant, S. Ramare, C. Laville, D. Barabas |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Kyphosis Lumbar vertebrae Osteotomy Fixation (surgical) Lumbar Postoperative Complications Deformity Foramen Medicine Humans Orthopedics and Sports Medicine Spondylitis Ankylosing Intraoperative Complications Lumbar Vertebrae business.industry Middle Aged medicine.disease Surgery Orthopedic Fixation Devices Radiography Pseudarthrosis medicine.anatomical_structure Treatment Outcome Female Original Article medicine.symptom business |
| Zdroj: | European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 6(4) |
| ISSN: | 0940-6719 |
| Popis: | Corrective surgery for kyphotic deformities of the spine in ankylosing spondylitis is a major surgery for rare indications. The authors report 31 lumbar osteotomies. The goal is to correct the deformity through a posterior limited approach and to minimise the neurological risks. The modifications developed by the authors for monosegmental closing wedge osteotomies are explained. The posterior resection is rhomboid shaped with a bilateral lamina removal. An osteotomy is performed in a forwards direction on the lateral aspects of the vertebral body without bone resection. This osteoclasty allows progressive vertebral body compression. Pediclectomy is associated if the corresponding foramen at the osteotomy level becomes too narrow in the process of redressing the spine. The resection level is adjusted so that superior and inferior posterior arches come into contact with a good compression. The authors point out the risk of lateral translation. Before the osteotomy, the two adjacent vertebrae are implanted with 5-mm cylindrical pedicular screws, so that posterior fixation can be carried out at any time. Posterior monobloc fixation allows for very great compression of the osteoclasty. The authors compare the results of their experiences in opening and closing osteotomy. They progressively changed their technique for closing osteotomies, because of published vascular complications and mechanical risks (instability and pseudarthrosis in opening osteotomies). Closing osteotomy also minimises the risk of stenosis with radicular compression or traction if an important correction is performed. The level of the osteotomy varied in this series, which had a correction rate of up to 75 degrees. The choice of level depends on secondary effects on pelvic position and projection of the centre of gravity. The preferred procedure remains a monosegmental correction because it is faster and easier, with minimum bleeding. Short monobloc posterior fixation is sufficient to maintain reduction and to obtain stability from posterior compression. |
| Databáze: | OpenAIRE |
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