Ming-liang Ji, Yong Qiu, Bang-ping Qian, Wei-jun Wang, Ze-zhang Zhu, Bin Wang, Hua Jiang

Transcription

1 Surgical correction of thoracolumbar/lumbar kyphosis secondary to ankylosing spondylitis : its effect on the anatomic relationship between superior mesenteric artery and the aorta Ming-liang Ji, Yong Qiu, Bang-ping Qian, Wei-jun Wang, Ze-zhang Zhu, Bin Wang, Hua Jiang Spine surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China *Correspondence to Yong Qiu ( scoliosis2002@sina.com)

2 Decreased angle and distance between the superior mesenteric artery (SMA) and the aorta (AO): crucial in the development of the superior mesenteric artery syndrome (SMAS) Anatomic relationship between SMA and AO changes during surgical correction of spinal deformity, especially in kyphosis patients. the result of spinal elongation However, not fully documented (Crowther MA et al, 2002; Altiok H et al, 2005; Ozkurt H, 2007 )

3 Objective To investigate the changes of anatomic relationship between SMA and AO in surgically-treated ankylosing spondylitis (AS) patients.

4 Patients and methods 21 AS patients ( 19, 2, age: 22 to 50 years (36 ± 8 years) ) Including criteria sigle-level lumbar pedicle subtraction osteotomy (PSO) no spinal pseudarthrosis or fracture Radiologic assessment: global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), angle and distance between SMA and AO

5 Measurements of the angle and distance between SMA and AO SMA AO On the sagittal reconstructed CT images showing SMA and AO, a line was drawn between the root of SMA and AO for angle measurements. SMA AO On axial CT images showing the third part of the duodenum, the maximum distance between the center of AO and the center of SMA was measured.

6 Results the changes of the angle and distance between SMA and AO after surgical correction 47.3º 32.7mm 32.4º A-28-year-old man with thoracolumbar kyphosis secondary to AS was treated by PSO (L2)

7 Table 1- Clinical and radiological data of patients N=21 Pre operation Post operation P value GK(º) 75.1±10.4 (65 110) 36.2±6.4 ( ) P=0.000 TK(º) 41.4±13.9 ( ) 35.1±11.6 ( ) P=0.000 LL(º) 1.7±10.5 ( ) 31.8±8.9 ( ) P=0.000 Aortomesenteric angle(º) Aortomesenteric distance(mm) 30.6±9.5 ( ) 24.8±9.7 ( ) P= ±7.6 ( ) 21±7.5 ( ) P=0.000

8 Table 2- The correlation between the changes of angle and distance and sagttial spinal parameters, respectively N=21 GK TK LL Angle R=0.553 R=0.476 R= p=0.009* P=0.029* P=0.576 Distance R=0.541 R=0.123 R= 0.03 P=0.011* P=0.595 P=0.886 * Statistically significant

9 Discussion & Conclusion Significant decreases of the angle and distance between SMA and AO were quantitatively confirmed in AS undergone surgical correction of kyphosis. These changes were prominently correlated with the correction of GK.

10 Discussion & Conclusion Based on the results of this study, the magnitude of kyposis correction should be considered when planning to correct kyphosis in AS patients through PSO, especially the correction of GK.

11 References Hutchinson DT, Bassett GS. Clin Orthop Relat Res, 1990 Crowther MA, Webb PJ, Eyre-Brook IA. Spine, 2002 Zhu ZZ, Qiu Y. World J gastroenterol, 2005 Altiok H, Lubicky JP, DeWald C, et al. Spine, 2005 Tsirikos AI, Jeans LA. J Spinal Disord Tech, 2005 Braun SV, Hedden DM, Howard AW. J Bone Joint Surg Am, 2006 Ozkurt H, Cenker MM, Bas N et al.surg Radiol Anat, 2007

12 Presenting Author Qiu Yong No Relationships Co-authors Ji Mingliang No Relationships Qian Bangping No Relationships Wang Weijun No Relationships Zhu Zezhang No Relationships Wang Bin No Relationships Jiang Hua No Relationships