Clinical Report: A Staged Sandwich Approach for Managing Kyphosis in AS
Overview
This case study presents a successful staged 'sandwich' protocol for managing severe kyphosis, scoliosis, and bilateral hip ankylosis in a patient with ankylosing spondylitis. The approach involved three surgical stages, resulting in significant improvements in spinal alignment and hip prosthesis positioning.
Background
Ankylosing spondylitis (AS) is a chronic inflammatory disorder that can lead to severe spinal deformities and hip ankylosis, significantly impairing patients' quality of life. Traditional surgical strategies for addressing these complex deformities often face biomechanical challenges. This report introduces a novel staged approach that may enhance surgical outcomes in patients with advanced AS.
Data Highlights
No numerical data provided in the source material.
Key Findings
The staged 'sandwich' protocol involved right total hip arthroplasty, followed by pedicle subtraction osteotomy, and concluded with contralateral total hip arthroplasty.
Postoperative radiographs showed marked improvement in spinal sagittal and coronal alignment.
The approach adhered to a biomechanical principle of 'unlock–rebalance–match' to restore mobility and alignment.
The first hip arthroplasty was performed to create a safer operative position rather than for final spinopelvic normalization.
The last hip arthroplasty was intentionally postponed until pelvic orientation stabilized after spinal correction.
Clinical Implications
The staged 'sandwich' approach may provide a systematic method for addressing complex hip-spine syndromes in advanced ankylosing spondylitis. This strategy could enhance surgical safety and improve long-term outcomes for patients with severe deformities.
Conclusion
This case study highlights the potential of a staged surgical approach in managing complex deformities associated with ankylosing spondylitis, offering insights into effective treatment strategies.
