Osteotomía de Thomasen en el desequilibrio sagital por espondilitis anquilopoyética

Rodrigo De Jesús Rajadel Alzuri, Raúl R. Candebat Rubio, Orestes Mauri Pérez

Texto completo:

PDF

Resumen

Introducción: La espondilitis anquilopoyética es una enfermedad inflamatoria crónica de etiología desconocida que afecta fundamentalmente al esqueleto axial y apendicular, con tendencia a la fibrosis y la anquilosis ósea progresiva. Está asociada a la limitación y a la incapacidad de carácter postural.

Objetivo: Demostrar que la osteotomía de Thomasen es un procedimiento efectivo para realizar la corrección y manejar el desequilibrio sagital, provocadas por la espondilitis anquilopoyética.

Presentación de caso: Se le realizó la osteotomía de sustracción pedicular (Thomasen) en la columna lumbar media (L3) con el objetivo de restituir el balance sagital lo más próximo posible a la normalidad. No se reportaron complicaciones.

Conclusiones: Se obtuvo un buen resultado funcional, con un alto grado de satisfacción del paciente, mejorando su calidad de vida. Este proceder es una de las opciones a tener en cuenta en la cirugía correctora espinal con resultado satisfactorio.

Palabras clave

osteotomía de sustracción pedicular; balance sagital; espondilitis anquilopoyética.

Referencias

Velasco Bustamante JA, Velasco Bustamante DL, Baquero Vallejo GA, Gómez Valverde JL, Villacres Pinza MA, Jinez Coca KA. Abordaje práctico de la espondiloartritis. Rev Cub Reumatol. 2019[acceso: 11/03/2021];21(3). Disponible en: http://scielo.sld.cu/pdf/rcur/v21n3/1817-5996-rcur-21-03-e101.pdf

Bridwell KH, Lewis SJ, Edwards C, Lenke LG, Iffrig TM, Berra A, et al. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine 2003;28:2093-101. PMID: 14501920.

Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM. Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine. 1999;24(16):1712-20. PMID: 10472106.

Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman Jr RA, Kim YJ, et al. Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine. 2007;32(20):2245-52. PMID: 17873818

Bari TJ, Hallager DW, Hansen LV, Dahl B, Gehrchen M. Reducing revision rates following pedicle subtraction osteotomy surgery: a single-center experience of trends over 7 years in patients with adult spinal deformity. Spine Deform. 2021;9(3):803-15. PMID 33400231

Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop. 1985;194:142-52. PMID: 3978906.

Van Royen BJ, De Gast A. Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis. 1999;58:399-406. PMID: 10381482

Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg [Am]. 2004;86(suppl1):44-50. PMID: 14996921

Wang Y, Li C, Liu L, Qi L. One‐level mini‐open pedicle subtraction osteotomy for treating spinal kyphosis in patients with ankylosing spondylitis. BMC Musculoskeletal Disorders. 2021;22:101. DOI: https://doi.org/10.1186/s12891-021-03974-7

Simmons ED. Kyphotic deformity of the spine in ankylosing spondylitis. Clinic Orthop Relat Research. 1977;(128):65-77. PMID: 598177.

Thiranont N, Netrawichien P. Transpedicular decancellation closed wedge vertebral osteotomy for treatment of fixed flexion deformity of spine in ankylosing spondylitis. Spine. 1993;18(16):2517-22. PMID: 8303457.

Sociedad iberoamericana de columna. Cuestionarios SRS-22 para el paciente en español. SIC. 2020 [acceso: 21/03/2021]. Disponible en: http://www.silaco.org/images/SRS22-CUESTIONARIO-PARA-EL-PACIENTE.pdf

Kose KC, Bozduman O, Yenigul AE, Igrek S. Spinal Osteotomies: Indications, limits and Pitfalls. EFORT Open Rev. 2017;2(3):73-82. PMID: 28507779

Wang MY, Bordon G. Mini-Open pedicle subtraction Osteotomy as a treatment for severe adult spinal deformities: case series with initial clinical and radiographic outcomes. J Neurosurg Spine. 2016;24(5):769-76. PMID: 26745348.

Sepriano A, Landewé R, van der Heijde D. Predictive validity of the ASAS classification criteria for axial and peripheral spondyloarthritis after follow-up in the ASAS cohort: A final analysis. Ann Rheum Dis. 2016;75(6):1034-42,. DOI: https://doi.org/10.1136/annrheumdis-2015-208730

Sepriano A, Rubio R, Ramiro S. Performance of the ASAS classification criteria for axial and peripheral spondyloarthritis: A systematic literature review and meta-analysis. Ann Rheum Dis. 2017;76(5):886-90. DOI: https://doi.org/10.1136/annrheumdis-2016-210747

Gupta MC, Gupta S, Kelly MP, Bridwell KH. Pedicle subtraction osteotomy. JBJS Essent Surg Tech. 2020;10(1):e0028.1-11. PMID: 32368407.

Charles YP, Ntilikina Y, Collinet A, Steib JP. Combined percutaneous and open instrumentation for thoracolumbar kyphosis correction by two-level pedicle subtraction osteotomy in ankylosing spondylitis. Eur J Orthop Surg Traumatol. 2020;30(5):939-47. PMID: 31980911

Tarawneh AM, Venkatesan M, Pasku D, Singh J, Quraishi NA. Impact of pedicle subtraction osteotomy on health-related quality of life (HRQOL) measures in patients undergoing surgery for adult spinal deformity: a systematic review and meta-analysis. Eur Spine J. 2020;29(12):2953-9. PMID: 32382878

Pizones J, Moreno Manzanaro L, Perez Grueso FJS, Vila Casademunt A, Yilgor C, Boissiere L, Alanay A, Kleinstück F, Acaroglu ER, Pellisé F, Obeid I; ESSG European Spine Study Group. Effect of lumbar pedicle subtraction osteotomy level on lordosis distribution and shape. Eur Spine J. 2020;29(6):1388-1396. PMID: 32328789.

Alzakri A, Boissière L, Cawley DT, Bourghli A, Pointillart V, Gille O, et al. L5 pedicle subtraction osteotomy: indication, surgical technique and specificities. Eur Spine J. 2018;27(3):644-51. PMID: 29188373.

Bronson WH, Dai A, Protopsaltis T. S1 Pedicle Subtraction Osteotomy for Fixed Sagittal Imbalance and Lumbosacral Kyphosis. Clin Spine Surg. 2019;32(6):233-6. PMID: 30520768.

Ha KY, Kim YH, Park HY, Cho CH, Kim SI. Surgical strategy for revisional lumbar pedicle subtraction osteotomy to correct fixed sagittal imbalance: The effect of the osteotomy level and iliac screw fixation. J Orthop Sci. 2020; S0949-2658(20)30247-5. PMID: 32896453.

Zhao SZ, Qian BP, Qiu Y, Qiao M, Liu ZJ, Huang JC. The relationship between global spinal alignment and pelvic orientation from standing to sitting following pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis. Arch Orthop Trauma Surg. 2019;139(6):761-8. PMID: 30610417.

Mao SH, Feng ZX, Qian BP, Qiu Y. Radiological morphology variances of osteotomized vertebra-disc complex following pedicle subtraction osteotomy for ankylosing spondylitis with thoracolumbar kyphosis: the incidence, mechanisms, and prognosis. Spine J. 2018;18(8):1363-73. PMID: 29253632.

Qian BP, Mao SH, Jiang J, Wang B, Qiu Y. Mechanisms, Predisposing Factors, and Prognosis of Intraoperative Vertebral Subluxation During Pedicle Subtraction Osteotomy in Surgical Correction of Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis. Spine (Phila Pa 1976). 2017;42(16):E983-E990. PMID: 28796721.

Mao SH, Feng ZX, Qian BP, Qiu Y. The clinical relevance of the presence of bridging syndesmophytes on kyphosis correction and maintenance following pedicle subtraction osteotomy for thoracolumbar kyphotic deformity in ankylosing spondylitis: a comparative cohort study. BMC Musculoskelet Disord. 2018;19(1):97. PMID: 29609565.

Huang JC, Qian BP, Qiu Y, Wang B, Yu Y, Qiao M. What is the optimal postoperative sagittal alignment in ankylosing spondylitis patients with thoracolumbar kyphosis following one-level pedicle subtraction osteotomy? Spine J. 2020;20(5):765-75. PMID: 31734451.

Barrey C, Jund J, Noseda O, Roussouly P. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J. 2007;16:1459-67. PMID: 17211522

Obeid I, Boissiere L, Yilgor C, Larrieu D, Pellise F, Alanay A, et al. Global tilt: A single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J. 2016;25:3644-9. PMID: 27323962.

Ahmad M, Muralidharan V, Dritan P, Jagdeep S, Nasir A. Impact of pedicle subtraction osteotomy on health‑related quality of life (HRQOL) measures in patients undergoing surgery for adult spinal deformity: a systematic review and meta‑analysis. European Spine Journal. 2020. DOI: https://doi.org/10.1007/s00586-020-06439-y

Burkhard D, Suter B, Sigris T. Pedicle subtraction osteotomy with patient-specific instruments. North American Spine Society J. 2021:100075. DOI: https://doi.org/10.1016/j.xnsj.2021.100075/

Tabares Neyra HI, Fleites Marrero EE, Tabares Sáez H, Morales Seife R. Influencia del balance sagital sobre los cambios degenerativos de la columna vertebral (I). Rev Cubana Ortop Traumatol. 2020 [acceso: 21/03/2021];34(2). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S0864-215X2020000200006&lng=es&nrm=iso&tlng=es

Le Huec JC, Leijssen P, Duarte M, Aunoble S. Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J. 2011;19(Suppl 3):S233-364. PMID: 21818597

Tabares Neyra H, Díaz Quesada JM, Tabares Sáez H, Tabares Sáez L. Actualización sobre prevención y tratamiento de la pérdida de sangre quirúrgica. Rev Cubana Ortop Traumatol. 2017 [acceso: 21/03/2021];31(1):92109. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S0864-215X2017000100009&lng=es&nrm=iso&tlng=es

Pola E, Papaleo P, Santoliquido A, Gasparini G, Aulis L, De Santis E, et al. Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. J Bone Joint Surg Am. 2004;86-A(1):57-61. PMID: 14711946.

Woodward LJ, Kam PCA. Ankilosing spondylitis: recent developments and anesthetic implications. Anaesthesia. 2009;64:540-48. PMID: 19413825.

Kim SK, Chung JY, Park YJ, Choi SW, Seo HY. Modified Pedicle Subtraction Osteotomy for Osteoporotic Vertebral Compression Fractures. Orthop Surg. 2020;12(2):388-95. PMID: 32107881.

Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003;43(4):459-69. PMID: 12662278.

Zang X, Wang Y. History of spinal osteotomy of ankylosing spondylitis kyphosis. In Wang Y. (Ed.) Surgical treatement of ankylosing spondylitis deformity. Sprinter. 2019. DOI: https://doi.org/10.1007/979-981-13-6427-3.2

Enlaces refback

  • No hay ningún enlace refback.


Bookmark and Share


Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional.