Treatment of ankylosing spondylitis complicated with a thoracolumbar Andersson lesion by posterior closed osteotomy, debridement and fusion through the fracture line

• Published in: BMC musculoskeletal disorders 2022-08, Vol.23 (1), p.1-815, Article 815
• Main Authors: Guo, Chaofeng, Li, Tao, Zhang, Hongqi, Gao, Qile, Zhang, Gengming, Liu, Jinyang, Wang, Yuxiang, Deng, Ang, Liu, Shaohua, Sun, Yang, Tang, Mingxing
• Format: Article
• Language: English
• Subjects: Andersson lesion (AL); Ankylosing spondylitis; Arthritis; Back pain; Care and treatment; Complications; Complications and side effects; Debridement; Fractures; Kyphosis; Mental health; Musculoskeletal diseases; Osteotomy; Patient outcomes; Patients; Posterior closed osteotomy, debridement and fusion through the fracture line; Postoperative; Prevention; Quality of life; Rehabilitation; Risk factors; Sacrum; Scoliosis; Self image; Spinal fusion; Spinal pseudarthrosis (SP); Spine (lumbar); Surgery; Thorax
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-022-05770-3

Background An Andersson lesion (AL) is a fatigue fracture occurring across three columns in ankylosing spondylitis (AS), resulting in spinal pseudarthrosis (SP) formation, most commonly in the thoracolumbar segment. However, there is still great controversy and few reports on the best surgical method for the treatment of AS combined with thoracolumbar AL. The purpose of this study was to investigate the efficacy of posterior closed osteotomy, debridement and fusion through the fracture line for the treatment of this disease. Methods The clinical data of 13 patients (male 8, female 5, mean age 50.6 years) with AS combined with thoracolumbar AL treated with posterior closed osteotomy, debridement and fusion through the fracture line were retrospectively analysed. The following parameters of the full-length lateral spine radiographs were measured preoperatively and at the last follow-up: cervical 7 tilt (C.sub.7T), global kyphosis (GK), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis (LK), angle of the fusion levels (AFL), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and sagittal vertical axis (SVA). The visual analog scale (VAS), Oswestry disability index (ODI) and Scoliosis Research Society-22 (SRS-22) scores were recorded preoperatively and at the last follow-up. Results The mean operation time was 345 min, the mean blood loss was 673 mL, and the mean follow-up time was 21.9 months. Compared with the preoperative values, the C.sub.7T, GK, TK, TLK, LK, AFL, PT, SS and SVA values of all patients were significantly improved at the last follow-up (P < 0.05); GK improved from 81.62 [+ or -] 16.11 to 50.15 [+ or -] 8.55, with an average of 31[degrees] of correction (F = 75.945, P