{"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":1792620552394,"version":"4.5.0"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>This study aimed to provide a method for determining the apical vertebra for pedicle subtraction osteotomy (PSO) in corrective surgery for patients with ankylosing spondylitis (AS) with thoracolumbar kyphosis (TLK).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The medical records of AS patients with TLK who underwent PSO between May 2009 and August 2022 were retrospectively reviewed, and 235 patients were included in the study. Using the proposed method, choosing the vertebra based on Kim\u2019s apex (KA), which is defined as the farthest vertebra from a line drawn from the center of the T10 vertebral body to the midpoint of the S1 upper endplate, the authors analyzed 229 patients with apices at T12, L1, or L2 (excluding L3 because of the small sample size, n = 6). They divided all patients into two groups. Group A (n = 144) underwent PSO at the KA vertebra, while group B (n = 85) underwent PSO at a different level. Demographic and radiological data, including sagittal spinopelvic parameters of the entire spine, were collected. An additional analysis was performed on patients with the same KA vertebra.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The vertebra distributions of patients based on KA were T12 (28 [12.2%]), L1 (119 [52.0%]), and L2 (82 [35.8%]). The corrections of sagittal vertical axis (SVA; 101.0 \u00b1 48.5 mm vs 82.0 \u00b1 53.8 mm, p = 0.010), global kyphosis (GK; 31.6\u00b0 \u00b1 10.0\u00b0 vs 26.4\u00b0 \u00b1 10.5\u00b0, p = 0.005), and TLK (29.4\u00b0 \u00b1 10.2\u00b0 vs 24.2\u00b0 \u00b1 12.9\u00b0, p = 0.012) in group A were significantly greater than those in group B, and there was no difference in the corrections of thoracic kyphosis (TK), lumbar lordosis, and pelvic incidence between the two groups. On further analysis, group A showed greater correction in TK (26.2\u00b0 \u00b1 13.7\u00b0 vs 0.1\u00b0 \u00b1 8.1\u00b0, p = 0.013) for patients with T12 as the KA; greater improvements in SVA (101.5 \u00b1 44.2 mm vs 73.4 \u00b1 48.7 mm, p = 0.020), GK (30.6\u00b0 \u00b1 11.0\u00b0 vs 25.0\u00b0 \u00b1 10.4\u00b0, p = 0.046), and TLK (32.6\u00b0 \u00b1 7.8\u00b0 vs 26.7\u00b0 \u00b1 9.9\u00b0, p = 0.012) for those with L1 as the KA; and significant correction in TLK (30.0\u00b0 \u00b1 6.3\u00b0 vs 4.3\u00b0 \u00b1 19.5\u00b0, p = 0.008) for patients with L2 as the KA, compared with group B.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>PSO at the apical vertebra provides a greater degree of correction of sagittal imbalance. The proposed method, selecting the vertebra based on KA, is easily reproducible for determining the apex level in AS patients with TLK.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.4.spine231218","type":"journal-article","created":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T01:59:09Z","timestamp":1719626349000},"page":"325-331","source":"Crossref","is-referenced-by-count":3,"title":["Determining the vertebra for pedicle subtraction osteotomy in surgical correction for ankylosing spondylitis with thoracolumbar kyphosis"],"prefix":"10.3171","volume":"41","author":[{"given":"Xiongjie","family":"Li","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul; and"},{"name":"Department of Orthopaedic Surgery, Kyung Hee University, Graduate School of Medicine, Seoul, South 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, Kyung Hee University, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Min","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Billy Francis","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Jik","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Surgical management of global sagittal deformity in ankylosing spondylitis","volume":"24","author":"Sansur CA","year":"2008","unstructured":"Sansur CA, Fu KM, Oskouian RJ Jr, Jagannathan J, Kuntz C IV, Shaffrey CI. 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Spine J. 2014;14(1):87\u201397."},{"issue":"6","key":"b21","series-title":"Eur Spine J","first-page":"492","article-title":"Deformity planning for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis","volume":"9","author":"Van Royen BJ","year":"2000","unstructured":"Van Royen BJ, De Gast A, Smit TH. Deformity planning for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Eur Spine J. 2000;9(6):492\u2013498."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/41\/3\/article-p325.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/41\/3\/article-p325.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/41\/3\/article-p325.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:18:57Z","timestamp":1733491137000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/41\/3\/article-p325.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,1]]},"references-count":21,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2024.4.spine231218","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2024,9,1]]}}}