The impact of corrective surgery for thoracolumbar kyphotic deformity on health-related quality of life in patients with ankylosing spondylitis

Abstract

INTRODUCTION: Ankylosing spondylitis is a chronic inflammatory disease. It might affect the facet, sacroiliac joint, and vertebra regions. It leads to thoracolumbar kyphotic deformity in the spine region. Both ankylosing spondylitis and kyphotic deformity impair the patients' quality of life. Our objective was to assess the impact of the correction of kyphotic deformity in ankylosing spondylitis on health-related quality of life. MATERIALS AND METHODS: 11 thoracolumbar kyphosis patients diagnosed with ankylosing spondylitis were operated and their deformity was corrected. Medical Outcome Study Short Form-36 (SF-36), visual analog scale (VAS), and Oswestry disability index (ODI) studies were performed on patients before surgery and 1 month after surgery to assess their impact on health-related quality of life. RESULTS: In our study, postoperative changes in the sub-parameters of the SF-36 test, which was used to assess the health-related quality of life of patients, were determined to be statistically significant compared to post-surgery. Likewise, postoperative changes in VAS and ODI tests compared to pre-surgery were also statistically significant. CONCLUSION: Corrective surgery of thoracolumbar kyphosis in patients with ankylosing spondylitis has a positive impact on both better health-related quality of life and recovery of back and low back pain.

Keywords

• Ankylosing spondylitis
• thoracolumbar kyphosis
• visual analog scale
• oswestry disability index
• health-related quality of life

References

1. Referans1. Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369(9570):1379–1390. doi: 10.1016/S0140-6736(07)60635-7.
2. Referans2. Zhang X, Zhang Z, Wang J, Lu M, Hu W, Wang Y, et al. Vertebral column decancellation: a new spinal osteotomy technique for correcting rigid thoracolumbar kyphosis in patients with ankylosing spondylitis. Bone Joint J. 2016;98-B(5):672–678. doi: 10.1302/0301-620X.98B5.35726.
3. Referans3. Qian BP, Qiu Y, Wang B, Sun X, Zhu ZZ, Jiang J, et al. Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis. Eur Spine J. 2012; 21:711–718. doi: 10.1007/s00586-011-2054-5.
4. Referans4. Kotsis K, Voulgari PV, Drosos AA, Carvalho AF, Hyphantis T. Expert Rev Pharmacoecon Outcomes Res. 2014 Dec;14(6):857-72. doi: 10.1586/14737167.2014.957679.
5. Referans5. J.E. Ware, C.D. Sherbourne. The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473-483.
6. Referans6. Geler-Kulcu D, Batıbay S, Ozturk G, Mesci N. The association of neuropathic pain and disease activity, functional level, and quality of life in patients with ankylosing spondylitis: a cross-sectional study.Turk J Med Sci. 2018 Apr 30;48(2):257-265. doi: 10.3906/sag-1707-147.
7. Referans7. Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain questionnaire. Physiotherapy. 1980;66:271–273.
8. Referans8. Yang X, Fan D, Xia Q, Wang M, Zhang X, Li X, Cai G, et al. The health-related quality of life of ankylosing spondylitis patients assessed by SF-36: a systematic review and meta-analysis. Qual Life Res. 2016 Nov;25(11):2711-2723. doi: 10.1007/s11136-016-1345-z.

9. Referans9. Ozgul A, Peker F, Taskaynatan MA, Tan AK, Dinçer K, Kalyon TA. Effect of ankylosing spondylitis on health-related quality of life and different aspects of social life in young patients. Clin Rheumatol. 2006;25:168–174. doi: 10.1007/s10067-005-1150-5.
10. Referans10. Chorus AM, Miedema HS, Boonen A, Van Der Linden S. Quality of life and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age. Ann Rheum Dis. 2003;62:1178–1184. doi: 10.1136/ard.2002.004861.
11. Referans11. Van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum. 1984;27:361–381. doi: 10.1002/art.1780270401.
12. Referans12. Fritz, J.M., & Irrgang, J.J. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Physical Therapy. 2001;81: 776- 788.
13. Referans13. Faiz KW. [VAS--visual analog scale]. Tidsskr Nor Laegeforen. 2014 Feb 11;134(3) 323. doi: 10.4045/tidsskr.13.1145.
14. Referans14. Chen B, Li J, He C, Li D, Tong W, Zou Y, et al. : Role of HLA-B27 in the pathogenesis of ankylosing spondylitis (Review). Mol Med Rep. 2017;15(4):1943–51. 10.3892/mmr.2017.6248.
15. Referans15. Golder V, Schachna L. Ankylosing spondylitis: an update. Aust Fam Physician. 2013 Nov;42(11):780-4.
16. Referans16. Garcia-Montoya L, Gul H, Emery P. Recent advances in ankylosing spondylitis: understanding the disease and management. F1000Res 2018 Sep 21;7:F1000 Faculty Rev-1512. doi: 10.12688/f1000research.14956.1. eCollection 2018.
17. Referans17. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res. 1969;66:6–9.
18. Referans18. Püschel J, Zielke K. Korrekturoperation bei Bechterew-Kyphose-Indikation, Technik, Ergebnisse. Zeitschrift für Orthopädie und Unfallchirurgie. 1982;120:338–342.
19. Referans19.Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res. 1985;194:142–152.
20. Referans20. Ward M.M., Weisman M.H., Davis J.C., Reveille J.D.. Risk factors for functional limitations in patients with long-standing ankylosing spondylitis. Arthritis and Rheumatism, 2001:53(5), 710–717. doi:10.1002/art.21444.
21. Referans21. Barlow J.H., Wright C.C., Williams B., Keat A.. Work disability among people with ankylosing spondylitis. Arthritis and Rheumatism. 2001; 45(5), 424–429.
22. Referans22. Feldtkeller E., Vosse D., Geusens P., Van der Linden S.Prevalence and annual incidence of vertebral fractures in patients with ankylosing spondylitis. Rheumatol Int. 26 (2006), pp. 234-239.
23. Referans23. Ragnarsdottir M, Geirsson AJ, Gudbjornsson B. Rib cage motion in ankylosing spondylitis patients: a pilot study. Spine J. 2008;8(3):505–509. doi: 10.1016/j.spinee.2006.12.009.
24. Referans24. O'Shea FD, Riarh R, Anton A, Inman RD. Assessing back pain: does the Oswestry Disability Questionnaire accurately measure function in ankylosing spondylitis? J Rheumatol. 2010 Jun;37(6):1211-3. doi: 10.3899/jrheum.091240.
25. Referans25. Connolly D, Fitzpatrick C, O'Shea F. Disease Activity, Occupational Participation, and Quality of Life for Individuals with and without Severe Fatigue in Ankylosing Spondylitis. Occup Ther Int. 2019 Jul 1;2019:3027280. doi: 10.1155/2019/3027280.