| Objective: To investigate the safety and effectiveness of one-stage posterior approach bone graft fusion and internal fixation surgical strategies for ankylosing spondylitis combined with thoracolumbar Andersson lesions.Methods: Clinical and radiographic data of 21 patients with ankylosing spondylitis combined with thoracolumbar Andersson lesions undertaken a simple spinal posterior approach from 2011 to 2017 in Xi'an Honghui Hospital were retrospectively reviewed.All patients had obvious back pain before surgery,and the symptom did not relieve after at least 3 months of conservative treatment.The lesion of anterior middle column is completely cleared and the bone graft is fused through posterior approach.According to different radiologic characteristics,10 patients without severe vertebral destruction and local kyphosis <30 ° were treated with posterior pedicle lateral approach debridement and interbody fusion;11 patients with severe adjacent vertebral body destruction and local kyphosis > 30 ° were treated with Smith-Petersen osteotomy and posterior interbody fusion.The clinical effectiveness was recorded and compared with visual analogue score(VAS)and Oswestry disability index(ODI)before and after surgery.According to the American Spinal Cord Injury Association(ASIA)scoring system,patients' neurological deficits and postoperative recovery were evaluated.Postoperative observations were performed to determine whether internal fixation failures such as withdrawal of nails,broken nails,or broken rods occurred.The Cobb angle of local kyphosis was recorded and compared before and after surgery and at the final follow-up,and observe the bone graft fusion.Results: All 21 patients successfully completed the operation,including 16 males and 5 females;with an average of 47.2 ± 13.9(range 29-79 years)years.The segments of Andersson lesions were T10/11 in 5 cases,T11/12 in 6 cases,T12/L1 in 8 cases and L1/L2 in 2 cases.There were no complications of spinal cord or nerve root injury during and after the operation.Dural sac tear occurred in 2 cases,and repair was performed during the operation.No cerebrospinal fluid leakage occurred after the operation.All patients received complete follow-up after surgery,with a follow-up time of 24-43 months,with an average of 30.3 ± months.During the follow-up,no loosening,pullout or breakage of the internal fixation occurred.Clinical symptoms improved significantly in all patients,with a VAS improvement of 6.8 points(5-8 points)and an ODI improvement of 46.7%(20-64%).In patients undertaken posterior pedicle lateral approach debridement and interbody fusion,the average operating time was 155.5 ± 17.2min(120-185min),and the average intraoperative blood loss was 460 ± 128.1ml(300-750ml).The average kyphosis correction was 10.8 °(0-18.5 °).In patients undertaken Smith-Petersen osteotomy and posterior interbody fusion,the average operating time was 148.2 ± 21.9min(125-180min),the average intraoperative blood loss was 391.8 ± 88.4ml(300-550ml),and the average kyphosis correction was 26.1 °(17.7-32.5 °).X-ray or CT at the final follow-up showed that the Andersson lesion segment had solid bony fusion.Six patients with neurological deficits completely recovered(4 ASIA D-E,2 ASIA C-E).Conclusion: Thoracolumbar Andersson lesion were treated with one-stage posterior approach debridement and bone graft fusion and internal fixation were performed at the same time.According to the clinical and radiologic characteristics of the thoracolumbar Andersson lesion,two different surgical strategies were adopted according to the extent of lesions and the degree of kyphosis,and both achieved satisfactory clinical results,good kyphosis correction and solid bony fusion.At the same time,it has the advantages of short operation time,less bleeding and fewer complications,and provides an alternative surgical strategy for the treatment of thoracolumbar Andersson lesion. |
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