A variety of kyphosis is common in clinical practice and can be caused by many different reasons, such as ankylosing spondylitis, old compression fractures of the vertebrae, and tuberculosis of the spine. In severe cases of kyphosis, patients are often unable to lie flat in bed when sleeping or even look straight ahead when walking, resulting in serious life impairment. What is the surgical treatment for this kyphosis (humpback)? Modern surgical treatment options have fundamentally changed from the previous surgical treatment options, as orthopedic spine surgery can be completed through a single posterior procedure.
Column Resection), Pedicle Subtraction (PSO), Osteotomy
Osteotomy), Smith-Peterson osteotomy (SPO), and Smith-Peterson
Osteotomy). In this article, we present a case of severe kyphosis with ankylosing spondylitis and describe how the kyphosis of the spine was subjected to orthopedic surgery and the results of correction. Ankylosing spondylitis tends to develop in young men, with symptoms such as low back pain and morning stiffness, and as the spine gradually fuses and grows into a stiff “column” with increasing age, the pain stops naturally. As people often bend over, this “pillar” often grows into a posterior convexity, which is often referred to as hunchback, and when the hunchback is severe, it is impossible to look straight ahead, or even to walk looking at the ground, which is very painful. In this case, surgical orthopedic surgery is needed to return the spine to its physiological state so that the patient can look straight ahead and sleep on a pillow (many of these patients cannot sleep on a pillow because the hunchback is too strong). This case is a 29-year-old young male with a diagnosis of ankylosing spondylitis and a severe hunchback, which seriously affects his life. The preoperative orthopantomogram showed no significant lateral convexity, so no lateral orthosis was needed at the time of surgery, and the original balance was maintained postoperatively. The preoperative lateral x-ray showed that the spine was obviously kyphotic and the head was in a low position, so the eyes could not be leveled. The kyphosis was corrected by 60 degrees, thus restoring the balance of the spine. So how was this done during the surgery? The position of the white arrow in the figure above is the location of the osteotomy of the second lumbar vertebra, with a wide resection of the posterior lamina and other structures and a small cut of the anterior vertebral body, so that the kyphosis can be corrected by 30 degrees through posterior closure. The white part indicated by the arrow in the figure shows that a 360-degree circumferential resection of the spine has been made, completely freeing the central nerve structures. After the lumbar spine is closed, the spine is then corrected by 30 degrees. Then the osteotomy of the 10th thoracic vertebra is performed in the same way as the lumbar vertebra, except that the surgical risk of the thoracic vertebra is much higher than that of the lumbar vertebra because the spinal cord is in the spinal canal above the thoracic vertebra, and if it is done incorrectly, it can cause postoperative paralysis of the lower limbs. Therefore, this step has to be performed with great care, as shown above, and the same beautiful 360-degree osteotomy around the spinal cord of the 10th thoracic vertebra (shown by the white arrow in the above figure) was done, with the resection pattern remaining V-shaped. This was then closed by compression to achieve another 30 degrees of correction. In the figure below, the upper thoracic 10 is also closed by compression and the spine is fixed in a position that restores the physiological force line by locking all the screws in place, at which point the kyphosis is corrected by 60 degrees: After the final orthopedic correction of the kyphosis is completed, an osteotomy, or fusion, is performed on the posterior surface of the spine to grow all the screw-fixed segments together by means of bone grafting, and the spine is then maintained in the orthopedic state forever. The spine is then maintained forever in its post-orthopedic state. With such PSO osteotomy of 2 vertebrae, such a severe stiff kyphosis can be well orthoped, thus restoring a physiological line of force to the spine and achieving satisfactory results. Of course, if the kyphosis is not very severe, an osteotomy of one vertebra can be performed to achieve good results. Relatively speaking, this surgery is the most difficult of all the operations for kyphosis because it requires two 360-degree osteotomies to “completely sever” the spine, which is already stiff and completely grown together, before it can be orthopedic, and the thousands of operations performed by the surgeon during this osteotomy cannot damage the spinal cord and nerve structures in the central spinal canal. The difficulty of the surgery is very high because the spinal cord and nerve structures in the central canal cannot be damaged during the thousands of operations. If the spine is not completely fused, the procedure is much easier and the surgical plan is sometimes simplified. Of course, the procedure must be performed by a very skilled spine surgeon. Electrophysiological monitoring during the surgery is also important and provides a good early warning to determine the harassment of the spinal cord and the improvement of its function.