PMID- 38064699 OWN - NLM STAT- MEDLINE DCOM- 20240304 LR - 20240304 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 40 IP - 3 DP - 2024 Mar 1 TI - Postoperative quality of life in patients with ankylosing spondylitis and thoracolumbar kyphosis: risk factors and personalized sagittal reconstruction strategy. PG - 365-374 LID - 10.3171/2023.9.SPINE23675 [doi] AB - OBJECTIVE: The aim of this study was to investigate the factors affecting postoperative quality of life in patients with ankylosing spondylitis (AS) and thoracolumbar kyphosis (TLK), and establish a personalized sagittal reconstruction strategy. METHODS: Patients with AS and TLK who underwent pedicle subtraction osteotomy (PSO) from February 2009 to May 2019 were retrospectively included. Quality of life and spinal sagittal radiographic parameters were collected before surgery and at the last follow-up. Patients were divided into two groups based on the attainment of minimal clinically important difference (MCID) on the Bath Ankylosing Spondylitis Functional Index and Oswestry Disability Index. Comparisons of radiographic parameters and clinical outcomes were conducted between and within groups. Regression analysis was used to identify the risk factors within the missing MCID cohort. Sagittal reconstruction equations were established using the pelvic incidence (PI) and thoracic inlet angle (TIA) in the reached MCID cohort. RESULTS: The study comprised 82 participants. Significant improvements were observed in most radiographic parameters and all quality-of-life indicators during the final follow-up compared with the preoperative measures (p < 0.05). Factors including cervical lordosis (CL) >/= 18 degrees (OR 9.75, 95% CI 2.26-58.01, p = 0.005), chin-brow vertical angle (CBVA) >/= 25 degrees (OR 14.7, 95% CI 3.29-91.21, p = 0.001), and pelvic tilt (PT) >/= 33 degrees (OR 21.77, 95% CI 5.92-103.44, p < 0.001) independently correlated with a failure to attain MCID (p < 0.05). Sagittal realignment targets were constructed as follows: sacral slope (SS) = 0.84 PI - 17.4 degrees (R2 = 0.81, p < 0.001), thoracic kyphosis (TK) = 0.51 PI + 10.8 degrees (R2 = 0.46, p = 0.002), neck tilt (NT) = 0.52 TIA - 5.8 degrees (R2 = 0.49, p < 0.001), and T1 slope (T1S) = 0.48 TIA + 5.8 degrees (R2 = 0.45, p = 0.002). CONCLUSIONS: PSO proved efficacious in treating AS complicated by TLK, yielding favorable outcomes. CBVA >/= 25 degrees , CL >/= 18 degrees , and PT >/= 33 degrees were the primary factors affecting postoperative quality of life in patients with AS. The personalized sagittal reconstruction strategy in this study focused on the subjective sensations and daily needs of patients with AS, which were delineated by the equations SS = 0.84 PI - 17.4 degrees , TK = 0.51 PI + 10.8 degrees , NT = 0.52 TIA - 5.8 degrees , and T1S = 0.48 TIA + 5.8 degrees . FAU - Lv, Xin AU - Lv X AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Huang, Renyuan AU - Huang R AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Zeng, Ziliang AU - Zeng Z AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Zhang, Di AU - Zhang D AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Li, Bo AU - Li B AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Lin, Yuhong AU - Lin Y AD - 2Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China. FAU - Zhang, Zhilei AU - Zhang Z AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Wang, Qiwei AU - Wang Q AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Nuertai, Yelidana AU - Nuertai Y AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Huang, Zhihao AU - Huang Z AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Wang, Zheyu AU - Wang Z AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Yang, Canchun AU - Yang C AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Yan, Haolin AU - Yan H AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Peng, Xiaoshuai AU - Peng X AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Zhao, Qiancheng AU - Zhao Q AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Li, Wenpeng AU - Li W AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Jiang, Xu AU - Jiang X AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Hu, Xumin AU - Hu X AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. FAU - Gao, Liangbin AU - Gao L AD - 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University; and. LA - eng PT - Journal Article DEP - 20231208 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Humans MH - *Spondylitis, Ankylosing/diagnostic imaging/surgery/complications MH - Quality of Life MH - Retrospective Studies MH - Thoracic Vertebrae/diagnostic imaging/surgery MH - *Kyphosis/diagnostic imaging/surgery/complications MH - *Lordosis/diagnostic imaging/surgery MH - Risk Factors OTO - NOTNLM OT - ankylosing spondylitis OT - lumbar OT - minimal clinically important difference OT - osteotomy OT - quality of life OT - sagittal parameters OT - thoracic OT - thoracolumbar kyphosis EDAT- 2023/12/08 18:42 MHDA- 2024/03/04 06:43 CRDT- 2023/12/08 16:53 PHST- 2023/06/20 00:00 [received] PHST- 2023/09/28 00:00 [accepted] PHST- 2024/03/04 06:43 [medline] PHST- 2023/12/08 18:42 [pubmed] PHST- 2023/12/08 16:53 [entrez] AID - 10.3171/2023.9.SPINE23675 [doi] PST - epublish SO - J Neurosurg Spine. 2023 Dec 8;40(3):365-374. doi: 10.3171/2023.9.SPINE23675. Print 2024 Mar 1.