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KMID : 0352119950110020218
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Journal of Kyung Hee University
1995 Volume.11 No. 2 p.218 ~ p.224
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Two Cases of Posterior Closed Lumbar Osteotomy in Kyphotic Deformity of Ankylosing Spondylitis
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Abstract
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Ankylosing spondylitis was described during the years of 1884~1898 by Strumpel et al. Its special features are progressive ankylosis of the sacroiliac joint and ossification of the annulus fibrosus of the discs and the interlaminar and
interspinous
ligaments, leading to severe fixed kyphosis, so extreme that patient can not stand, sit, or lie in comfort. There are limitation in conservative treatment to delay the progression of the disease. So osteotomy for correction must be needed. The
purposes
of surgical treatment are to restore the patients' ability to see ahead to the horizon, to relieve compression of the abdominal viscera by the rib margin, and to improve the diaphragmatic respiration on which these patients often depend. In 1948,
Smith-Perterson, Larson and Aufranc first reported multiple level osteotomies through the articular processes with resection of the spinous processes, closing wedge osteotomies of the posterior elements and elongation of anterior column by
disruption
of anterior longitudinal ligament. Many authors have modified this procedure. In 1985, Thomasen described a method which gave a correction by posterior closed wedge osteotomies through transpedicular decancellation for the treatment of fixed
kyphosis in
Ankylosing spondylitis., The advantages of this procedure are; first, instead of breaking the anterior longitudinal ligament, preserving it as a hinge to pivot the osteoclasis. Second the risk of damaging the nerve root or cauda equina is
reduced.
Third, healing is rapid and predictable because two cancellous surface are being compressed together. Fourth, harmonious lumbar lordosis is restored. We corrected 2 cases of fixed kyphotic deformity secondary to Ankylosing spondylitis by the
technique
mentioned above. Major complications which consisted of dura tear, cord injury, thrombosis in major vessels were not found in all cases. Body jacket cast were applied in all cases. Patient's satisfaction was great in body configuration and
posture.
It
can be considered to evaluate results of this procedure in long-term follow up continuously.
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KEYWORD
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