• Spine · Jul 2005

    Comparative Study

    Closing wedge osteotomy versus opening wedge osteotomy in ankylosing spondylitis with thoracolumbar kyphotic deformity.

    • Kao-Wha Chang, Ying-Yu Chen, Chien-Chung Lin, Hsiang-Lan Hsu, and Ke-Chun Pai.
    • Taiwan Spine Center, Department of Orthopaedic Surgery, Armed Forces Taichung General Hospital, Taiwan, Republic of China. iscspine@ms45.url.com.tw
    • Spine. 2005 Jul 15;30(14):1584-93.

    Study DesignRetrospective.ObjectivesTo compare lumbar posterior opening wedge osteotomy (OWO) and closing wedge osteotomy (CWO) in patients with thoracolumbar kyphotic deformity attributable to ankylosing spondylitis.Summary Of Background DataOWO and CWO have been used to correct ankylosing spondylitis-related kyphotic deformity, but the ideal surgical procedure remains controversial.MethodsSixty-six patients underwent OWO, and 51 underwent CWO (102 male, 15 female; mean age, 34.8 years; age range, 17-55 years). Radiographic results, complications, and patient satisfaction were analyzed over a mean follow-up of 3.6 years (range, 2.1-5.3 years)ResultsFor OWO and CWO, mean operative times were 183 and 218 minutes, and mean blood losses were 1101 and 1915 mL, respectively. Lumbar lordosis increased by 37 degrees with OWO versus 36 degrees with CWO group, as shown on final radiographs. Sagittal imbalance improved 80 and 77 mm with OWO and CWO, respectively. Complications included delayed union in three patients and a broken rod at the osteotomy site in the OWO group. Six transient neurologic deficits occurred overall. No mortality or major complications occurred. Five patients developed junctional kyphosis (two undergoing OWO, three undergoing CWO), and all required repeat operation. Satisfactory clinical outcomes were achieved in both groups.ConclusionBoth OWO and CWO were safe and enabled substantial correction, with good clinical results. CWO resulted in a significantly longer operative time and more bleeding but offered fewer instances of paralytic ileus or delayed union with a broken rod.

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