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Published in: European Spine Journal 8/2016

01-08-2016 | Original Article

Optimal chin-brow vertical angle for sagittal visual fields in ankylosing spondylitis kyphosis

Authors: Kai Song, Xiaojing Su, Yonggang Zhang, Chao Liu, Xiangyu Tang, Guoying Zhang, Guoquan Zheng, Geng Cui, Xuesong Zhang, Keya Mao, Zheng Wang, Yan Wang

Published in: European Spine Journal | Issue 8/2016

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Abstract

Purpose

Chin-brow vertical angle (CBVA) is very important in correction of thoracolumbar kyphotic deformity in ankylosing spondylitis (AS), especially for the patients with cervical ankylosis. In previous study, Suk et al. stated that the patients with CBVA between −10° and 10° had better horizontal gaze. Unfortunately, in our clinical practice, we found the patients with CBVA between −10° and 10° after surgery usually complained of difficulty in cooking, cleaning, desk working and the like, although they had excellent horizontal gaze. In other words, for the patients with cervical ankylosis, good horizontal gaze existed together with poor downward gaze. Then, which condition do the patients prefer? Is there a compromise solution that makes a better quality life possible for the patients? In this research, we studied AS patients with cervical ankylosis, aiming to investigate the optimal CBVA for deformity correction.

Methods

25 AS thoracolumbar kyphotic patients with cervical ankylosis were studied, whose function and expectation of visual field related to life quality were assessed by questionnaire before and after surgery. Pre- and post-operative CBVA were obtained on lateral photos of the patients with free-standing posture, and 50 cases of CBVA were included, which were divided into six groups according to the angle irrespective of surgery (Group A, CBVA <0°; Group B, 0° ≤ CBVA < 10°; Group C, 10° ≤ CBVA < 20°; Group D, 20° ≤ CBVA < 30°; Group E, 30° ≤ CBVA < 40°; Group F, CBVA ≥ 40°). Kruskal–Wallis test was used to assess all the groups in terms of various items in the questionnaire, while Mann–Whitney test was used to assess every two groups.

Results

In overall evaluation, Group C (10°–20°) obtained the optimal expectation (p < 0.05); Group B, C and D (0°–30°) obtained better function (p < 0.05), and there was no significant difference between the 3 groups. In appearance, Group A, B and C (<20°) were better than the other groups both in function and expectation (p < 0.05), without dramatic difference among the three groups. In outdoor activities, Group A, B, C and D (<30°) were better in most of the items (p < 0.05). In indoor activities, Group C and D (10-30°) were much better (p < 0.05).

Conclusion

AS thoracolumbar kyphotic patients with cervical ankylosis had the best satisfaction when 10° ≤ CBVA < 20°.
Literature
1.
go back to reference Bridwell KH, Lewis SJ, Lenke LG et al (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85-A:454–463PubMed Bridwell KH, Lewis SJ, Lenke LG et al (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85-A:454–463PubMed
2.
go back to reference Debarge R, Demey G, Roussouly P (2010) Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J 19:65–70CrossRefPubMed Debarge R, Demey G, Roussouly P (2010) Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J 19:65–70CrossRefPubMed
3.
go back to reference DL/T 525.2-1999 (2000) Ergonomic principles for the design of control centres part 2: visual fields and zones of field of vision. Power Automation Research Institute of State Power Corporation (China) DL/T 525.2-1999 (2000) Ergonomic principles for the design of control centres part 2: visual fields and zones of field of vision. Power Automation Research Institute of State Power Corporation (China)
4.
5.
go back to reference ISO 9355-2-1999 (1999) Ergonomic requirements for the design of displays and control actuators—part 2: displays. International Organization for Standardization (ISO) ISO 9355-2-1999 (1999) Ergonomic requirements for the design of displays and control actuators—part 2: displays. International Organization for Standardization (ISO)
6.
go back to reference Kim KT, Suk KS, Cho YJ et al (2002) Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine 27:612–618CrossRefPubMed Kim KT, Suk KS, Cho YJ et al (2002) Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine 27:612–618CrossRefPubMed
7.
go back to reference Lazennec JY, Saillant G, Saidi K et al (1997) Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients. Eur Spine J 6:222–232CrossRefPubMedPubMedCentral Lazennec JY, Saillant G, Saidi K et al (1997) Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients. Eur Spine J 6:222–232CrossRefPubMedPubMedCentral
8.
go back to reference Le Huec JCL, Saddiki R, Franke J et al (2011) Equilibrium of the human body and the gravity line: the basics. Eur Spine J 20:S558–S563CrossRef Le Huec JCL, Saddiki R, Franke J et al (2011) Equilibrium of the human body and the gravity line: the basics. Eur Spine J 20:S558–S563CrossRef
9.
go back to reference Raoof S, Feigin D, Sung A et al (2012) Interpretation of plain chest roentgenogram. Chest 141(2):545–558CrossRefPubMed Raoof S, Feigin D, Sung A et al (2012) Interpretation of plain chest roentgenogram. Chest 141(2):545–558CrossRefPubMed
10.
go back to reference Roussouly P, Gollogly S, Noseda O et al (2006) The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine 31:E320–E325CrossRefPubMed Roussouly P, Gollogly S, Noseda O et al (2006) The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine 31:E320–E325CrossRefPubMed
11.
go back to reference Sengupta DK, Khazim R, Grevitt MP et al (2001) Flexion osteotomy of the cervical spine: a new technique for correction of iatrogenic extension deformity in ankylosing spondylitis. Spine 26:1068–1072CrossRefPubMed Sengupta DK, Khazim R, Grevitt MP et al (2001) Flexion osteotomy of the cervical spine: a new technique for correction of iatrogenic extension deformity in ankylosing spondylitis. Spine 26:1068–1072CrossRefPubMed
12.
go back to reference Scheer JK, Tang JA, Smith JS et al (2013) Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19(2):p141–p159CrossRef Scheer JK, Tang JA, Smith JS et al (2013) Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19(2):p141–p159CrossRef
13.
go back to reference Schwab F, Lafage V, Boyce R et al (2006) Gravity line analysis in adult volunteers age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine 31:E959–E967CrossRefPubMed Schwab F, Lafage V, Boyce R et al (2006) Gravity line analysis in adult volunteers age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine 31:E959–E967CrossRefPubMed
14.
go back to reference Shin JK, Lee JS, Goh TS et al (2014) Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis. Eur Spine J 23(1):p242–p247CrossRef Shin JK, Lee JS, Goh TS et al (2014) Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis. Eur Spine J 23(1):p242–p247CrossRef
15.
go back to reference Smith-Petersen MN, Larson CB, Aufranc OE (1945) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg 27:1–11 Smith-Petersen MN, Larson CB, Aufranc OE (1945) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg 27:1–11
16.
go back to reference Song K, Zheng G, Zhang Y et al (2013) A new method for calculating the exact angle required for spinal osteotomy. Spine (Phila Pa 1976) 38(10):E616–E620CrossRef Song K, Zheng G, Zhang Y et al (2013) A new method for calculating the exact angle required for spinal osteotomy. Spine (Phila Pa 1976) 38(10):E616–E620CrossRef
17.
go back to reference Song K, Zheng G, Zhang Y et al (2014) Hilus pulmonis as the center of gravity for AS thoracolumbar kyphosis. Eur Spine J 23(12):2743–2750CrossRefPubMed Song K, Zheng G, Zhang Y et al (2014) Hilus pulmonis as the center of gravity for AS thoracolumbar kyphosis. Eur Spine J 23(12):2743–2750CrossRefPubMed
18.
go back to reference Suk KS, Kim KT, Lee SH et al (2003) Significance of chinbrow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine 28:2001–2005CrossRefPubMed Suk KS, Kim KT, Lee SH et al (2003) Significance of chinbrow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine 28:2001–2005CrossRefPubMed
19.
go back to reference Van Royen BJ, De Gast A (1999) Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis 58:399–406CrossRefPubMedPubMedCentral Van Royen BJ, De Gast A (1999) Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis 58:399–406CrossRefPubMedPubMedCentral
20.
go back to reference Van Royen BJ, Gast AD, Smit TH (2000) Deformity planning for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Eur Spine J 9:492–498CrossRefPubMedPubMedCentral Van Royen BJ, Gast AD, Smit TH (2000) Deformity planning for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Eur Spine J 9:492–498CrossRefPubMedPubMedCentral
21.
go back to reference Van Royen BJ, Slot GH (1995) Closing wedge posterior osteotomy for ankylosing spondylitis. J Bone Joint Surg [Br] 77:117–121 Van Royen BJ, Slot GH (1995) Closing wedge posterior osteotomy for ankylosing spondylitis. J Bone Joint Surg [Br] 77:117–121
22.
go back to reference Zhang HQ, Huang J, Guo CF et al (2014) Two-level pedicle subtraction osteotomy for severe thoracolumbar kyphotic deformity in ankylosing spondylitis. Eur Spine J 23(1):p234–p241CrossRef Zhang HQ, Huang J, Guo CF et al (2014) Two-level pedicle subtraction osteotomy for severe thoracolumbar kyphotic deformity in ankylosing spondylitis. Eur Spine J 23(1):p234–p241CrossRef
Metadata
Title
Optimal chin-brow vertical angle for sagittal visual fields in ankylosing spondylitis kyphosis
Authors
Kai Song
Xiaojing Su
Yonggang Zhang
Chao Liu
Xiangyu Tang
Guoying Zhang
Guoquan Zheng
Geng Cui
Xuesong Zhang
Keya Mao
Zheng Wang
Yan Wang
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 8/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-016-4588-z

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