Spinal Osteotomy in Patients With Ankylosing Spondylitis: Complications During First Postoperative Year

In Brief Study Design. A historic cohort to determine short-term complications after 115 corrective osteotomies of the cervical and lumbar spine in patients with ankylosing spondylitis. Objectives. To describe the nature of complications of spinal osteotomies and sequelae. Summary of Background Data. Little is known about the rate and nature of complications after spinal osteotomy in these patients. Methods. A chart review of 106 patients (age, 21–82 years) was conducted. The following surgical techniques were performed: cervical-thoracic extending osteotomy at C6-Th1 (n = 22), lumbar closing-wedge osteotomy (n = 62), polysegmental lumbar osteotomy (n = 20), or a combined anterior-posterior lumbar correction (n = 11). Results. Many complications (7.8% permanent neurologic deficit, 9.6% deep wound infections, and 10.4% major general complications) occurred after performing a spinal correction. Since 1998, there is a tendency for a lower rate of infections but a higher rate of neurologic and major general complications. Because of 27% deep wound infections and 18% major general complications, the technique of combined anterior and posterior surgery has been abandoned. Conclusion. High complication rates in this group of patients are partly due to the difficult surgery but also to the underlying disease. The surgery should be concentrated in specialized centers. One hundred and fifteen corrective osteotomies of the cervical and lumbar spine in patients with ankylosing spondylitis were analyzed for the short-term complications. Life-threatening major complications, deep wound infections, and neurologic complications occur frequently in patients with ankylosing spondylitis and more frequently than in other series in the literature of adult deformity surgery.