{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T22:09:12Z","timestamp":1792620552963,"version":"4.5.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The purpose of this study was to investigate the rate of and the risk factors for surgery-related complications demonstrated on radiography after pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis in patients with ankylosing spondylitis (AS).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors retrospectively reviewed the medical records of 230 consecutive patients with thoracolumbar kyphosis due to AS who had undergone 1-level PSO at a single institution in the period from 2010 to 2017. The causes of surgery-related complications were divided into two types: surgical\/technical failure and mechanical failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The patients consisted of 20 women and 210 men, with an average age of 43.4 years. The average follow-up period was 39.0 months. The preoperative sagittal vertical axis was 18.5 \u00b1 69.3 cm, which improved to 4.9 \u00b1 4.6 cm after PSO. Of the 77 patients (33.5%) who experienced minor or major surgery-related complications, 56 had complications related to surgical\/technical failure (overall incidence 24.3%) and 21 had complications related to mechanical failure (overall incidence 9.1%). Fourteen patients (6.1%) underwent reoperation. However, among the 77 patients with complications, the rate of revision surgery was 18.2%. The most common radiological complications were as follows: sagittal translation in 24 patients, coronal imbalance in 20, under-correction in 8, delayed union in 8, and distal junctional failure and kyphosis in 8. The most common causes of reoperation were coronal imbalance in 4 patients, symptomatic malposition of pedicle screws in 3, and distal junctional failure in 3. Delayed union was statistically correlated with posterior sagittal translation (p = 0.007).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>PSO can provide acceptable radiographic outcomes for the correction of thoracolumbar kyphosis in patients with AS. However, a high incidence of surgery-related complications related to mechanical failure and surgical technique can develop. Thorough radiographic investigation before and during surgery is needed to determine whether complete ossification occurs along the anterior and posterior longitudinal ligaments of the spine.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2020.3.spine191355","type":"journal-article","created":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T07:23:57Z","timestamp":1589527437000},"page":"366-372","source":"Crossref","is-referenced-by-count":6,"title":["Radiographic findings for surgery-related complications after pedicle subtraction osteotomy for thoracolumbar kyphosis in 230 patients with ankylosing spondylitis"],"prefix":"10.3171","volume":"33","author":[{"given":"Keun-Ho","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki-Tack","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Chan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joong-Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kee-Yong","family":"Ha","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"b1","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.1016\/j.spinee.2013.11.013","article-title":"Spinal osteotomy in ankylosing spondylitis: radiological, clinical, and psychological results","volume":"14","author":"Park YS","year":"2014","unstructured":"Park YS, Kim HS, Baek SW. Spinal osteotomy in ankylosing spondylitis: radiological, clinical, and psychological results. Spine J. 2014;14(9):1921\u20131927.10.1016\/j.spinee.2013.11.01324252235"},{"issue":"6","key":"b2","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1097\/00007632-200203150-00010","article-title":"Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity","volume":"27","author":"Kim KT","year":"2002","unstructured":"Kim KT, Suk KS, Cho YJ,  Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine (Phila Pa 1976). 2002;27(6):612\u2013618.10.1097\/00007632-200203150-00010"},{"issue":"16","key":"b3","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E983","DOI":"10.1097\/BRS.0000000000002015","article-title":"Mechanisms, predisposing factors, and prognosis of intraoperative vertebral subluxation during pedicle subtraction osteotomy in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis","volume":"42","author":"Qian BP","year":"2017","unstructured":"Qian BP, Mao SH, Jiang J,  Mechanisms, predisposing factors, and prognosis of intraoperative vertebral subluxation during pedicle subtraction osteotomy in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis. Spine (Phila Pa 1976). 2017;42(16):E983\u2013E990.10.1097\/BRS.0000000000002015"},{"issue":"4","key":"b4","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1097\/01.brs.0000199893.71141.59","article-title":"Transpedicular lumbar wedge resection osteotomy for fixed sagittal imbalance: surgical technique and early results","volume":"31","author":"Boachie-Adjei O","year":"2006","unstructured":"Boachie-Adjei O, Ferguson JA, Pigeon RG, Peskin MR. Transpedicular lumbar wedge resection osteotomy for fixed sagittal imbalance: surgical technique and early results. Spine (Phila Pa 1976). 2006;31(4):485\u2013492.10.1097\/01.brs.0000199893.71141.59"},{"issue":"66","key":"b5","series-title":"Clin Orthop Relat Res","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1097\/00003086-196909000-00003","article-title":"Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis","volume":"66","author":"Smith-Petersen MN","year":"1969","unstructured":"Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res. 1969;66(66):6\u20139.10.1097\/00003086-196909000-000035357786"},{"issue":"14","key":"b6","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1682","DOI":"10.1097\/01.brs.0000170590.21071.c1","article-title":"Posterior vertebral column resection for severe rigid scoliosis","volume":"30","author":"Suk SI","year":"2005","unstructured":"Suk SI, Chung ER, Kim JH,  Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976). 2005;30(14):1682\u20131687.10.1097\/01.brs.0000170590.21071.c1"},{"key":"b7","series-title":"Clin Orthop Relat Res","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1097\/00003086-198504000-00019","article-title":"Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis","volume":"194","author":"Thomasen E","year":"1985","unstructured":"Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res. 1985;(194):142\u2013152.10.1097\/00003086-198504000-00019"},{"issue":"8","key":"b8","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1097\/BRS.0000000000000815","article-title":"Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis","volume":"40","author":"Liu H","year":"2015","unstructured":"Liu H, Yang C, Zheng Z,  Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2015;40(8):570\u2013579.10.1097\/BRS.0000000000000815"},{"issue":"20","key":"b9","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2245","DOI":"10.1097\/BRS.0b013e31814b2d52","article-title":"Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment","volume":"32","author":"Buchowski JM","year":"2007","unstructured":"Buchowski JM, Bridwell KH, Lenke LG,  Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976). 2007;32(20):2245\u20132252.10.1097\/BRS.0b013e31814b2d52"},{"issue":"8","key":"b10","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1016\/j.spinee.2017.12.006","article-title":"Analysis of risk factors for sagittal translation after pedicle subtraction osteotomy in patients with ankylosing spondylitis","volume":"18","author":"Park JS","year":"2018","unstructured":"Park JS, Kim J, Joo IH,  Analysis of risk factors for sagittal translation after pedicle subtraction osteotomy in patients with ankylosing spondylitis. Spine J. 2018;18(8):1356\u20131362.10.1016\/j.spinee.2017.12.00629305072"},{"issue":"suppl 1","key":"b11","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"S49","DOI":"10.1007\/s00586-014-3670-7","article-title":"Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities","volume":"24","author":"Berjano P","year":"2015","unstructured":"Berjano P, Aebi M. Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities. Eur Spine J. 2015;24(suppl 1):S49\u2013S57.2548795210.1007\/s00586-014-3670-7"},{"issue":"9","key":"b12","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1097\/BSD.0b013e3182aab2ff","article-title":"Coronal spinal balance in adult spine deformity patients with long spinal fusions: a minimum 2- to 5-year follow-up study","volume":"28","author":"Ploumis A","year":"2015","unstructured":"Ploumis A, Simpson AK, Cha TD,  Coronal spinal balance in adult spine deformity patients with long spinal fusions: a minimum 2- to 5-year follow-up study. J Spinal Disord Tech. 2015;28(9):341\u2013347.2407741810.1097\/BSD.0b013e3182aab2ff"},{"issue":"10","key":"b13","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1097\/01.brs.0000216479.09250.96","article-title":"Sagittal translation in opening wedge osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis","volume":"31","author":"Chang KW","year":"2006","unstructured":"Chang KW, Chen HC, Chen YY,  Sagittal translation in opening wedge osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. Spine (Phila Pa 1976). 2006;31(10):1137\u20131142.10.1097\/01.brs.0000216479.09250.96"},{"issue":"14","key":"b14","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1643","DOI":"10.1097\/01.brs.0000169451.76359.49","article-title":"Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis","volume":"30","author":"Glattes RC","year":"2005","unstructured":"Glattes RC, Bridwell KH, Lenke LG,  Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976). 2005;30(14):1643\u20131649.10.1097\/01.brs.0000169451.76359.49"},{"issue":"1","key":"b15","series-title":"Evid Based Spine Care J","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1055\/s-0033-1341604","article-title":"Vertebral osteotomies in ankylosing spondylitis\u2014comparison of outcomes following closing wedge osteotomy versus opening wedge osteotomy: a systematic review","volume":"4","author":"Ravinsky RA","year":"2013","unstructured":"Ravinsky RA, Ouellet JA, Brodt ED, Dettori JR. Vertebral osteotomies in ankylosing spondylitis\u2014comparison of outcomes following closing wedge osteotomy versus opening wedge osteotomy: a systematic review. Evid Based Spine Care J. 2013;4(1):18\u201329.10.1055\/s-0033-134160424436696"},{"issue":"1","key":"b16","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1097\/00007632-200501010-00018","article-title":"Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year","volume":"30","author":"Willems KF","year":"2005","unstructured":"Willems KF, Slot GH, Anderson PG,  Spinal osteotomy in patients with ankylosing spondylitis: complications during first postoperative year. Spine (Phila Pa 1976). 2005;30(1):101\u2013107.10.1097\/00007632-200501010-00018"},{"issue":"5","key":"b17","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"560","DOI":"10.3171\/2017.3.SPINE16357","article-title":"Sagittal alignment and complications following lumbar 3-column osteotomy: does the level of resection matter?","volume":"27","author":"Ferrero E","year":"2017","unstructured":"Ferrero E, Liabaud B, Henry JK,  Sagittal alignment and complications following lumbar 3-column osteotomy: does the level of resection matter? J Neurosurg Spine. 2017;27(5):560\u2013569.2888512810.3171\/2017.3.SPINE16357"},{"issue":"20","key":"b18","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2189","DOI":"10.1097\/BRS.0b013e31814b8371","article-title":"Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study","volume":"32","author":"Kim YJ","year":"2007","unstructured":"Kim YJ, Bridwell KH, Lenke LG,  Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976). 2007;32(20):2189\u20132197.10.1097\/BRS.0b013e31814b8371"},{"issue":"11","key":"b19","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1097\/BRS.0000000000000304","article-title":"Revision surgery after 3-column osteotomy in 335 patients with adult spinal deformity: intercenter variability and risk factors","volume":"39","author":"Maier SP","year":"2014","unstructured":"Maier SP, Smith JS, Schwab FJ,  Revision surgery after 3-column osteotomy in 335 patients with adult spinal deformity: intercenter variability and risk factors. Spine (Phila Pa 1976). 2014;39(11):881\u2013885.10.1097\/BRS.0000000000000304"},{"issue":"1","key":"b20","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s00586-009-1104-8","article-title":"Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis","volume":"19","author":"Kiaer T","year":"2010","unstructured":"Kiaer T, Gehrchen M. Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis. Eur Spine J. 2010;19(1):57\u201364.10.1007\/s00586-009-1104-819662442"},{"issue":"16","key":"b21","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E354","DOI":"10.1097\/00007632-200108150-00010","article-title":"Transpedicular wedge osteotomy for correction of thoracolumbar kyphosis in ankylosing spondylitis: experience with 78 patients","volume":"26","author":"Chen IH","year":"2001","unstructured":"Chen IH, Chien JT, Yu TC. Transpedicular wedge osteotomy for correction of thoracolumbar kyphosis in ankylosing spondylitis: experience with 78 patients. Spine (Phila Pa 1976). 2001;26(16):E354\u2013E360.10.1097\/00007632-200108150-00010"},{"issue":"2","key":"b22","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E99","DOI":"10.1097\/BRS.0000000000002773","article-title":"Coronal imbalance after three-column osteotomy in thoracolumbar congenital kyphoscoliosis: incidence and risk factors","volume":"44","author":"Xu L","year":"2019","unstructured":"Xu L, Chen X, Qiao J,  Coronal imbalance after three-column osteotomy in thoracolumbar congenital kyphoscoliosis: incidence and risk factors. Spine (Phila Pa 1976). 2019;44(2):E99\u2013E106.10.1097\/BRS.0000000000002773"},{"issue":"20","key":"b23","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1673","DOI":"10.1097\/BRS.0b013e3182091fba","article-title":"Analysis of radiographic parameters relevant to the lowest instrumented vertebrae and postoperative coronal balance in Lenke 5C patients","volume":"36","author":"Li J","year":"2011","unstructured":"Li J, Hwang SW, Shi Z,  Analysis of radiographic parameters relevant to the lowest instrumented vertebrae and postoperative coronal balance in Lenke 5C patients. Spine (Phila Pa 1976). 2011;36(20):1673\u20131678.10.1097\/BRS.0b013e3182091fba"},{"issue":"6","key":"b24","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1007\/s00586-016-4844-2","article-title":"Coronal balance in idiopathic scoliosis: a radiological study after posterior fusion of thoracolumbar\/lumbar curves (Lenke 5 or 6)","volume":"26","author":"Yang C","year":"2017","unstructured":"Yang C, Zhao Y, Zhai X,  Coronal balance in idiopathic scoliosis: a radiological study after posterior fusion of thoracolumbar\/lumbar curves (Lenke 5 or 6). Eur Spine J. 2017;26(6):1775\u20131781.2784423010.1007\/s00586-016-4844-2"},{"issue":"9","key":"b25","series-title":"Bone Joint J","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1302\/0301-620X.98B9.37273","article-title":"Coronal imbalance in degenerative lumbar scoliosis: prevalence and influence on surgical decision-making for spinal osteotomy","volume":"98-B","author":"Bao H","year":"2016","unstructured":"Bao H, Yan P, Qiu Y,  Coronal imbalance in degenerative lumbar scoliosis: prevalence and influence on surgical decision-making for spinal osteotomy. Bone Joint J. 2016;98-B(9):1227\u20131233.10.1302\/0301-620X.98B9.3727327587525"},{"issue":"1","key":"b26","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"75","DOI":"10.3171\/2017.11.SPINE17228","article-title":"Risk factor analysis of proximal junctional kyphosis after posterior osteotomy in patients with ankylosing spondylitis","volume":"29","author":"Wang T","year":"2018","unstructured":"Wang T, Zhao Y, Liang Y,  Risk factor analysis of proximal junctional kyphosis after posterior osteotomy in patients with ankylosing spondylitis. J Neurosurg Spine. 2018;29(1):75\u201380.2967667110.3171\/2017.11.SPINE17228"},{"issue":"1","key":"b27","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.spinee.2018.05.024","article-title":"Does solid fusion eliminate rod fracture after pedicle subtraction osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis?","volume":"19","author":"Zhao SZ","year":"2019","unstructured":"Zhao SZ, Qian BP, Qiao M,  Does solid fusion eliminate rod fracture after pedicle subtraction osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis? Spine J. 2019;19(1):79\u201386.10.1016\/j.spinee.2018.05.02429792999"},{"issue":"4","key":"b28","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/BF01322443","article-title":"Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients","volume":"6","author":"Lazennec JY","year":"1997","unstructured":"Lazennec JY, Saillant G, Saidi K,  Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients. Eur Spine J. 1997;6(4):222\u2013232.10.1007\/BF013224439294745"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/33\/3\/article-p366.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/33\/3\/article-p366.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/33\/3\/article-p366.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T21:09:03Z","timestamp":1680383343000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/33\/3\/article-p366.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":28,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2020.3.spine191355","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2020,9]]}}}