ArticleBMC musculoskeletal disorders2025
When to select two-level modified pedicle subtraction osteotomy in severe kyphosis secondary to ankylosing spondylitis?
Article in BMC musculoskeletal disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Sandwich strategy for the treatment of kyphosis with scoliosis and bilateral hip ankylosis in ankylosing spondylitis: a case report.Frontiers in surgery · 2026Article
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6 authors.
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Abstract
backgroundTwo-level osteotomy has emerged as an effective technique for addressing severe kyphosis secondary to ankylosing spondylitis (AS). Despite its efficacy, there remains a lack of consensus regarding the criteria for determining the necessity of two-level osteotomy. This study aimed to investigate precise and direct preoperative predictors for selection of two-level osteotomy in patients with severe AS kyphosis.
methodsA retrospective cohort of 101 AS patients was analyzed, including 33 patients who underwent two-level modified pedicle subtraction osteotomy (PSO) and 68 patients who underwent one-level modified PSO. Radiographic parameters, including pelvic tilt, pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), global kyphosis (GK), sagittal vertical axis (SVA), chin-brow vertical angle (CBVA), and osteotomized vertebral angle, were measured. Clinical outcomes were assessed using Oswestry Disability Index and Scoliosis Research Society-22 questionnaire. Comparative analyses of radiographic and clinical outcomes were conducted across different patient groups. Preoperative predictors for selecting two-level osteotomy were identified through receiver-operating characteristic curve analysis and logistic regression analysis.
resultsPatients undergoing two-level osteotomy exhibited significantly higher preoperative parameters of SS, LL, TK, GK, SVA, and CBVA compared to those receiving one-level osteotomy (P < 0.05). Notably, CBVA, GK, and SVA were identified as the most influential parameters influencing the selection of two-level osteotomy, with optimal threshold values of 63.9°, 91.1°, and 25.4 cm, respectively. Logistic regression analysis revealed CBVA and GK as independent predictors for selecting two-level osteotomy (P < 0.05). Patients undergoing lumbar region two-level osteotomy demonstrated larger SVA (P < 0.05) and pelvic incidence (PI; P = 0.267), whereas those with thoracic and lumbar osteotomy exhibited increased TK (P = 0.465). All patients achieved favorable clinical outcomes at final follow-up (P < 0.05).
conclusionsPreoperative CBVA, GK, and SVA are key parameters influencing the selection of two-level modified PSO for AS kyphosis. Specifically, preoperative CBVA > 63.9° and GK > 91.1° serve as independent predictors, with SVA > 25.4 cm acting as an auxiliary criterion. The choice of osteotomy sites is predominantly influenced by preoperative SVA, PI, and TK measurements. LEVEL OF EVIDENCE: Level IV, therapeutic study.
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