Skip to main content
Log in

Transpedicular wedge resection osteotomy for the treatment of a kyphotic Andersson lesion-complicating ankylosing spondylitis

  • Ideas and Technical Innovations
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Two cases with a long-standing thoracolumbar kyphosis due to ankylosing spondylitis are presented with a symptomatic localized destructive kyphotic lesion of the spine. Clinical and radiographic findings demonstrated a progressive vertebral and discovertebral kyphotic pseudarthrosis, known as an Andersson lesion, at the L1 and L1-2 level, respectively. Surgical correction and stabilization was performed by an extending transpedicular wedge resection osteotomy to restore spinal stability, to facilitate fracture healing as well as to restore the sagittal balance of the ankylosed spine. To predict the effect of a surgical correction of the Andersson lesion on the sagittal balance, deformity planning was performed preoperatively. The indication for surgery, the surgical technique and the 2 years’ clinical results are described. In addition, the difficulties experienced with preoperative deformity planning are evaluated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Andersson O (1937) Röntgenbilden vid spondylarthritis ankylopoetica. Nord Med Tidskr 14:2000–2002

    Google Scholar 

  2. Berven SH, Deviren V, Smith JA, Emami A, Hu SS, Bradford DS (2001) Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine 26:2036–2043

    Article  PubMed  CAS  Google Scholar 

  3. Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85-A:454–463

    PubMed  Google Scholar 

  4. Cawley MI, Chalmers TM, Kellgren JH, Ball J (1972) Destructive lesions of vertebral bodies in ankylosing spondylitis. Ann Rheum Dis 31:345–358

    Article  PubMed  CAS  Google Scholar 

  5. Dihlmann W, Delling G (1978) Disco-vertebral destructive lesions (so-called Andersson lesions) associated with ankylosing spondylitis. Skeletal Radiol 3:10–16

    Article  Google Scholar 

  6. Dihlmann W, Lindenfelser R (1979) Polysegmentäre Andersson Läsion bei ankylosierender spondylitis (röntgenologisch-histologische synopsis). Rofo 130:454–460

    PubMed  CAS  Google Scholar 

  7. Fang D, Leong JC, Ho EK, Chan FL, Chow SP (1988) Spinal pseudarthrosis in ankylosing spondylitis. Clinicopathological correlation and the results of anterior spinal fusion. J Bone Joint Surg Br 70:443–447

    PubMed  CAS  Google Scholar 

  8. Finkelstein JA, Chapman JR, Mirza S (1999) Occult vertebral fractures in ankylosing spondylitis. Spinal Cord 37:444–447

    Article  PubMed  CAS  Google Scholar 

  9. Gelman MI, Umber JS (1978) Fractures of the thoracolumbar spine in ankylosing spondylitis. AJR Am J Roentgenol 130:485–491

    PubMed  CAS  Google Scholar 

  10. Hunter T, Dubo HI (1983) Spinal fractures complicating ankylosing spondylitis. A long-term followup study. Arthritis Rheum 26:751–759

    Article  PubMed  CAS  Google Scholar 

  11. Obradov M, Schonfeld DH, Franssen MJ, de Rooy DJ (2001) Andersson lesion in ankylosing spondylitis. JBR–BTR 84:71

    PubMed  CAS  Google Scholar 

  12. Pettersson T, Laasonen L, Leirisalo-Repo M, Tervahartiala P (1996) Spinal pseudoarthrosis complicating ankylosing spondylitis: a report of two patients. Br J Rheumatol 35:1319–1323

    Article  PubMed  CAS  Google Scholar 

  13. Rivelis M, Freiberger RH (1969) Vertebral destruction at unfused segments in late ankylosing spondylitis. Radiology 93:251–256

    PubMed  CAS  Google Scholar 

  14. Sengupta DK, Khazim R, Grevitt MP, Webb JK (2001) Flexion osteotomy of the cervical spine: a new technique for correction of iatrogenic extension deformity in ankylosing spondylitis. Spine 26:1068–1072

    Article  PubMed  CAS  Google Scholar 

  15. Sparenberg A, Hamm B, Wolf KJ (1989) Ankylosierende spondylitis: Andersson-Läsion. Rofo 150:744–745

    PubMed  CAS  Google Scholar 

  16. Thorngren KG, Liedberg E, Aspelin P (1981) Fractures of the thoracic and lumbar spine in ankylosing spondylitis. Arch Orthop Trauma Surg 98:101–107

    Article  PubMed  CAS  Google Scholar 

  17. Unsal E, Arici AM, Kavukcu S, Pirnar T (2002) Andersson lesion: spondylitis erosiva in adolescents. Two cases and review of the literature. Pediatr Radiol 32:183–187

    Article  PubMed  Google Scholar 

  18. Van Royen BJ (1999) Lumbar osteotomy in ankylosing spondylitis, biomechanical and clinical aspects. Thesis, Vrije Universiteit, Amsterdam

  19. 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 58:399–406

    Article  PubMed  Google Scholar 

  20. Van Royen BJ, De Gast A, Smit TH (2000) Deformity planning for sagittal plane corrective osteotomies of the spine in ankylosing spondylitis. Eur Spine J 9:492–498

    Article  PubMed  Google Scholar 

  21. Van Royen BJ, Slot GH (1995) Closing-wedge posterior osteotomy for ankylosing spondylitis. Partial corporectomy and transpedicular fixation in 22 cases. J Bone Joint Surg Br 77:117–121

    PubMed  Google Scholar 

  22. Von Bechterew W (1893) Steifigkeit der wirbelsäule und ihre Verkrümmung als besondere Erkrankungsform. Neurologisches Zentralbl 12:426–434

    Google Scholar 

  23. Wu PC, Fang D, Ho EK, Leong JC (1988) The pathogenesis of extensive discovertebral destruction in ankylosing spondylitis. Clin Orthop 230:154–161

    PubMed  Google Scholar 

  24. Yau AC, Chan RN (1974) Stress fracture of the fused lumbo-dorsal spine in ankylosing spondylitis. A report of three cases. J Bone Joint Surg Br 56-B:681–687

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to B. J. Van Royen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Van Royen, B., Kastelijns, R., Noske, D. et al. Transpedicular wedge resection osteotomy for the treatment of a kyphotic Andersson lesion-complicating ankylosing spondylitis. Eur Spine J 15, 246–252 (2006). https://doi.org/10.1007/s00586-005-1008-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-005-1008-1

Keywords

Navigation