Analysis of neurological complications of spinal osteotomy for thoracolumbar and lumbar kyphosis in ankylosing spondylitis / 中华骨科杂志

ABSTRACT

Objective To analyze cause and preventative measures of neurological complications of spinal osteotomy for thoracolumbar and lumbar kyphosis in ankylosing spondylitis.Methods Data of 126 patients with kyphosis caused by ankylosing spondylitis,who had undergone spinal osteotomy in our hospital from January 2006 to January 2012,were retrospectively analyzed.Among them,18 patients developed neurological complications after spinal osteotomy,including 15 males and 3 females,aged from 25 to 56 years.The average preoperative Cobb angle of these patients was 76.3°.According to American Spinal Injury Association (ASIA) classification,all patients were rated as grade E.Results All 18 patients were followed up for 6 to 49 months (average,35 months).The postoperative Cobb angle ranged from 19° to 38° (average,27°).The average Cobb angle was corrected 49.3°.Neurological complications included spinal cord injury (3 cases) and nerve root injury (15 cases).The reasons of spinal cord injury consisted of sagittal migration of vertebra,spinal stenosis due to operation and iatrogenic cervical spine fracture and dislocation.The reasons of nerve root injury included compression injury (2 cases),malposition of screw (1 case) and excessive drag of nerve root during osteotomy (12 cases).Conclusion Nerve injury is one of the most serious complications of spinal osteotomy in the treatment of kyphosis in ankylosing spondylitis.The incidence of the neurological complications could be obviously reduced by fully decompressing,making patients in a proper surgical position,recognizing the pathological nature of ankylosing spondylitis and avoiding sagittal migration of osteotomy part.