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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)
Spine Surgery, Drum Tower Hospital, Nanjing University, China
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)
z
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 )
Spine Surgery, Drum Tower Hospital, Nanjing University, China
Objective
z To investigate the changes of anatomic relationship
between SMA and AO in surgically-treated ankylosing
spondylitis (AS) patients.
Spine Surgery, Drum Tower Hospital, Nanjing University, China
Patients and methods
¾ 21 AS patients ( ♂ 19 , ♀2, age: 22 to 50 years (36 ± 8 years) )
¾Including criteria
zsigle-level lumbar pedicle subtraction osteotomy (PSO)
zno spinal pseudarthrosis or fracture
¾Radiologic assessment: global kyphosis (GK), thoracic kyphosis (TK),
lumbar lordosis (LL),
angle and distance between SMA and AO
Spine Surgery, Drum Tower Hospital, Nanjing University, China
Measurements of the angle and distance between
SMA and AO
• On the sagittal reconstructed
CT images showing SMA and
SMA
AO, a line was drawn between
AO
the root of SMA and AO for
angle measurements.
• On axial CT images showing
the third part of the duodenum,
SMA
the maximum distance between
AO
the center of AO and the center
of SMA was measured.
Spine Surgery, Drum Tower Hospital, Nanjing University, China
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)
Spine Surgery, Drum Tower Hospital, Nanjing University, China
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 (31.5‐62.5)
P=0.000
TK(º)
41.4±13.9 (25‐89.7)
35.1±11.6 (21.4‐76.4)
P=0.000
LL(º)
1.7±10.5 (‐23.3‐14.6)
‐31.8±8.9 (‐19‐ ‐50.9)
P=0.000
Aortomesenteric angle(º)
30.6±9.5 (19.8‐49.8)
24.8±9.7 (12.5‐42)
P=0.000
Aortomesenteric distance(mm)
26±7.6 (14.5‐47.3)
21±7.5 (9.8‐42.5)
P=0.000
Spine Surgery, Drum Tower Hospital, Nanjing University, China
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
p=0.009*
R=0.476
P=0.029*
R=‐0.132
P=0.576
Distance R=0.541
P=0.011*
R=0.123
P=0.595
R=‐0.03
P=0.886
* Statistically significant
Spine Surgery, Drum Tower Hospital, Nanjing University, China
Discussion & Conclusion
¾ Significant decreases of the angle and distance between
SMA and AO were quantitatively confirmed in AS
undergone surgical correction of kyphosis.
¾ These changes were prominently correlated with the
correction of GK.
Spine Surgery, Drum Tower Hospital, Nanjing University, China
Discussion & Conclusion
¾ 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.
Spine Surgery, Drum Tower Hospital, Nanjing University, China
References
z
Hutchinson DT, Bassett GS. Clin Orthop Relat Res, 1990
z
Crowther MA, Webb PJ, Eyre-Brook IA. Spine, 2002
z
Zhu ZZ, Qiu Y. World J gastroenterol, 2005
z
Altiok H, Lubicky JP, DeWald C, et al. Spine, 2005
z
Tsirikos AI, Jeans LA. J Spinal Disord Tech, 2005
z
Braun SV, Hedden DM, Howard AW. J Bone Joint Surg Am, 2006
z
Ozkurt H, Cenker MM, Bas N et al.Surg Radiol Anat, 2007
Spine Surgery, Drum Tower Hospital, Nanjing University, China
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
Spine Surgery, Drum Tower Hospital, Nanjing University, China