Two-stage double-level rotational osteotomy in the treatment of congenital radioulnar synostosis

Congenital proximal radioulnar synostosis is a rare congenital anomaly that can be extremely disabling, especially when it occurs bilaterally or if there is severe hyperpronation. Currently, osteotomy to achieve a neutral or slightly pronated position is widely accepted for the management of patients who have severe pronation. The present study evaluates the result of two-stage double-level rotational osteotomy of both the radius and ulna in the treatment of severe congenital radioulnar synostosis. Nine children with severe congenital radioulnar synostosis underwent two-stage double-level rotational osteotomy of both the radius and ulna at Mansoura University Hospital. There were seven boys and two girls with a mean age of 5.6 years who were followed up for a mean of 26 months. The position of the forearm was improved from a mean pronation deformity of 76 degrees (60 degrees to 85 degrees) to 30 degrees of pronation in the affected dominant extremities and 20 degrees of supination in non-dominant extremities in all cases. Bony union was achieved by 5.9 weeks with no loss of correction. The advantages of this technique are that it is easy, safe, with absence of severe postoperative complications and requires a small surgical scar. A drawback of the technique is that the rotation correction depends only on a cast, so that a correction loss might occur if the plaster cast loosens.     

Pro- und Supinationseinschränkungen bei Torsionsfehlstellungen der Radiusdiaphyse vor und nach Ulnaosteotomie

The aim of this experimental study was to measure the exact influence of torsional deformities at the middle third of the radial shaft before and after osteotomy of the ulnar shaft on the rotation of the forearm. Intact and fresh cadaver specimens were fixed in a newly developed apparatus that allowed free pronation and supination. A ring fixator was applied to the radial shaft with K wires that allowed torsional deformities to be stabilized in steps of 10 degrees. The middle of the radial shaft was osteotomized via a small soft tissue window leaving the other soft tissues including the interosseous membrane intact. Supination and pronation were measured using a goniometer in a standardized fashion. The mean supination value before osteotomy of the radius was 71.6 degrees [standard deviation (SD)15.2 degrees], the mean pronation value was 64.5 degrees (SD 12.4 degrees). Radial osteotomy caused no significant difference in the range of motion prior to creation of torsional deformities. Supination torsional deformities greater than 30 degrees showed a significant loss of pronation and pronation torsional deformities greater than 30 degrees resulted in a significant loss of supination in 14 fresh cadavers, respectively. The amount of mean rotational loss was approximately the same in the respective pronation and supination torsional deformities. In the next step the influence of an ulna osteotomy on the range of motion was evaluated in different torsional deformities. In the four cadavers measured, there was an increase of the range of motion in the direction of the torsional deformity. These values were not significant when compared to values before ulna osteotomy, but there were significant changes to the non deformity (p=0.004 for pronation, p=0.003 for supination). Impairment of range of motion in the opposite direction of the deformity showed a similar appearance as values before ulna osteotomy. Again, there were significant changes to the non deformity (p=0.003 for pronation, p=0.005 for supination).     

Corrective osteotomies of the radius and ulna for supination contracture of the pediatric and adolescent forearm secondary to neurologic injury

PURPOSE: To present the authors' experience with internal fixation of the radius and ulna as a surgical option for correction of supination contracture of the forearm. METHODS: Twelve patients (13 limbs) had an osteotomy of the radius and ulna for a supination deformity secondary to a residual brachial plexus or spinal cord injury. Surgery consisted of proximal ulna and distal radius osteotomies combined with plate fixation. RESULTS: The average age of the patients at the time of surgery was 11 years. Five limbs had fixed supination deformities and 8 limbs lacked pronation beyond neutral. The average preoperative supination deformity (either fixed or measured at midarc) was 76 degrees. The average intraoperative correction was 86 degrees. The average follow-up period was 16 months. The average midrange resting position maintained at final follow-up evaluation was 2 degrees of pronation. All limbs ultimately obtained radiographic and clinical union of the osteotomy sites. Complications included 6 plate fractures; however, only 1 patient required revision internal fixation. CONCLUSIONS: The combination of a proximal ulna and distal radius osteotomy with internal fixation can provide excellent correction, but the implant must be strong enough to hold the osteotomies rigidly in the corrected position during the time needed for union. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

Surgical correction of supination deformity in children with obstetric brachial plexus palsy

We present a series of 40 children who were operated on for supination contracture following severe obstetric brachial plexus palsy. Surgery was done at an average age of 7 years and the mean postoperative follow-up was 4 years. In the 23 cases treated by an open or closed radial osteotomy, the mean intraoperative derotation was 78 degrees, the immediate postoperative position was 29 degrees pronation and it stabilized at follow-up at 17 degrees pronation. Biceps rerouting was performed in 17 cases without any recurrence of supination deformity and the final position was 22 degrees pronation. Some active forearm rotation was obtained in a few cases. These surgical corrections are part of an overall treatment plan and allow the "begging hand" to be corrected to a more functional and less noticeable position.     

Rotational deformity in malunited fractures of the distal radius

PURPOSE: To evaluate rotational deformity in malunited fractures of the distal radius and its effect on forearm rotation. METHODS: Thirty-seven patients with a symptomatic malunion of the distal radius (25 with dorsal angulation and 12 with volar angulation) were assessed for rotational deformity of the distal fragment. Spiral computed tomographic scans were taken of both wrists. Rotational deformity was evaluated by comparing the radial torsion angle of the injured and uninjured sides according to Frahm. Multivariable regression analyses were used to identify the radiologic parameter that had the most important influence on forearm rotation. RESULTS: Of the 37 patients, 23 showed a rotational deformity of the distal radius. In both dorsally and volarly angulated malunions, pronation and supination deformities were identified. There was a tendency toward more pronation deformities with volar malunion. Volar angulated malunion with a rotational deformity of less than 10 degrees showed the smallest amount of forearm supination. Losses of pronation-supination did not correlate with the amount of rotational deformity. CONCLUSIONS: This study showed that rotational deformity is common with angulated malunions of the distal radius. The effect on forearm rotation should not be overestimated. Pretreatment computed tomographic scanning of both wrists to identify and measure malrotation of the distal radius may be helpful to improve the outcome after corrective osteotomy.     

Minimally invasive single-session double-level rotational osteotomy of the forearm bones to correct fixed pronation deformity in congenital proximal radioulnar synostosis

BackgroundCongenital proximal radioulnar synostosis is the most common congenital disease of the elbow joints and forearms.MethodsThis was a prospective study of 12 consecutive children (14 forearms) who presented to the National Institute of Neuromotor System in Egypt between September 2012 and September 2013 with severe congenital proximal radioulnar synostosis, having a mean pronation deformity of 70.7° (range 60°–85°), and who underwent operative correction by single-session double-level rotational osteotomy and percutaneous intramedullary K-wires of both the radius and ulna. Ten forearms were type III, and four were type II according to Cleary and Omer classification. The mean age at the time of surgery was 5 years and 2 months (range 4 years and 10 months to 6 years and 5 months). They were evaluated for functional results after rotational corrective osteotomy at a mean interval of 30.4 months (range 24–36 months) by physical examination and radiographs.ResultsAll children had a mean pronation deformity correction of 59.8° (range 30°–90°) reaching a final position of 20°–30° of pronation in the affected dominant extremities and 20° of supination in the affected non-dominant extremities after osteotomy. All children showed improvement in functional activities, with no loss of correction or non-union in any child, and no circulatory disturbances, neuropathies, or hypertrophic scars.ConclusionMinimally invasive single-session double-level rotation osteotomy of the proximal ulna and distal radius with percutaneous intramedullary K-wire fixation is a safe, technically simple and efficient procedure which corrects pronation deformity.     

Varus inclination of the distal femur and high tibial osteotomy

We have analysed retrospectively the relationship between the axial parameters of alignment of the lower limb and the recurrence of varus deformity after high tibial osteotomy. We studied 29 patients (37 knees) with a mean age at surgery of 66 years. The mean follow-up was for 7.4 years (5 to 10.5). Recurrence of varus deformity was defined as an increase in the femorotibial angle of 3 degrees or more, compared with that obtained six months after the operation. There were four patients (four knees) with recurrence of varus deformity. They had a greater varus inclination of the distal femur than those without varus recurrence. An association between varus inclination of the distal femur and horizontal obliquity of the joint surface was observed. Excessive obliquity prevents the shift of weight-bearing to the lateral compartment, and may cause a recurrence of varus deformity after high tibial osteotomy.     

The effect of derotational humeral osteotomy on global shoulder function in brachial plexus birth palsy

BACKGROUND: Derotational humeral osteotomies have been used in older children with brachial plexus birth palsy and glenohumeral joint deformity to place the upper extremity in a more functional position. The purpose of this study was to determine the effects of these procedures on shoulder function and joint morphology. METHODS: Forty-three patients underwent a derotational humeral osteotomy for functional impairment in the setting of internal rotation contracture and/or glenohumeral joint deformity at our institution from 1996 to 2004. Osteotomies were performed proximal to the deltoid insertion and were stabilized with plate-and-screw fixation. The average age of the patients at the time of surgery was 7.6 years (range, 2.3 to 17.0 years). Shoulder function was graded according to the modified Mallet classification system. Glenohumeral deformity was graded according to the classification scheme of Waters et al. The results for twenty-seven patients who were followed for a minimum of two years (average, 3.7 years) are reported. RESULTS: The average amount of external rotation achieved with osteotomy was 64 degrees (range, 35 degrees to 90 degrees). The mean aggregate Mallet classification score improved from 13 to 18 points (p < 0.01). The mean Mallet classification scores for the individual elements similarly demonstrated improvement following osteotomy, with the greatest gains in hand-to-mouth, hand-to-neck, and external rotation motions. The mean classification of the glenohumeral deformity was type IV preoperatively and postoperatively, signifying the persistence of glenohumeral dysplasia. There were no nonunions. One patient required a revision osteotomy for inadequate initial correction. One patient sustained a humeral fracture distal to the plate fixation because of sports-related trauma. CONCLUSIONS: Derotational humeral osteotomy improves shoulder function in patients with brachial plexus birth palsy, internal rotation contracture, and/or advanced glenohumeral joint deformity. This osteotomy provides an attractive treatment option for patients with brachial plexus birth palsy who have advanced glenohumeral dysplasia precluding soft-tissue releases and tendon transfers.     

How does torsional deformity of the radial shaft influence the rotation of the forearm? A biomechanical study

OBJECTIVE: The aim of this experimental study was to measure the exact influence of isolated torsional deformities at the middle third of the radial shaft on the rotation of the forearm. DESIGN: Biomechanical study in cadavers. SETTING: Trauma Surgery Research Laboratories at the Medical School of Hannover, Hannover, Germany. INTERVENTION: Fourteen intact and fresh cadaver specimens were fixed in a newly developed apparatus that allowed free pronation and supination. A ring fixator was applied to the radial shaft with K-wires that allowed us to stabilize torsional deformities in steps of 10 degrees. The middle of the radial shaft was osteotomized via a small soft tissue window, leaving the other soft tissues, including the interosseous membrane, intact. MAIN OUTCOME MEASUREMENT: Supination and pronation were measured using a goniometer in a standardized fashion. RESULTS: The mean (standard deviation) supination value before osteotomy of the radius was 71.6 degrees (15.2 degrees), and the mean (standard deviation) pronation value was 64.5 degrees (12.4 degrees). Radial osteotomy caused no significant difference in the range of motion before creation of torsional deformities. Supination torsional deformities >30 degrees showed a significant loss of pronation. In turn, pronation torsional deformities >30 degrees resulted in a significant loss of supination. The amount of mean rotational loss was approximately the same in the respective pronation and supination torsional deformities. CONCLUSION: An axial torsional deformity of the radius of >30 degrees causes a statistically significant loss of forearm rotation in fresh cadavers.     

Massive allograft replacement of hemiarticular traumatic defects of the elbow

Four elbow osteoarticular allografts were done for four patients as salvage procedures for unreconstructable elbow fracture malunions. With a mean follow-up of 60 months (range, 12 to 72 months) all elbows were stable, free of pain, and had mean motion of 130 degrees active flexion and 27 degrees of flexion deformity, 67 degrees pronation and 62 degrees supination (preoperative mean: 104 degrees flexion, 42 degrees flexion contracture, 20 degrees pronation, and 34 degrees supination). Complications occurred in two elbows. One had a deep infection necessitating graft removal and subsequent regrafting. The second had an olecranon osteotomy nonunion. Elbow allografting is recommended as a salvage procedure for massive posttraumatic articular defects, bone loss, or malunion when neither arthrodesis nor conventional arthroplasty is indicated.     

The Spike Osteotomy for Hallux Valgus: A Clinical and Radiological Evaluation

A distal metatarsal osteotomy with soft tissue correction is a frequently performed operation to correct mild to moderate hallux valgus deformity. This is a prospective study of 28 feet in 25 patients who underwent spike osteotomy of the first metatarsal with medial capsulorraphy for symptomatic hallux valgus. The osteotomy is a distal metatarsal osteotomy with a spike fashioned in the plantar and lateral quarter of the proximal fragment and impacted into the trough created in the center of the distal fragment, providing lateral and plantar shift of the distal fragment. The American Orthopaedic Foot and Ankle Society's rating scale was used for functional assessment, and a visual analog scale gauged pain. The average follow-up was 27 months. The rating scale score improved from a mean preoperative value of 39/100 to 84/100. Twenty-six feet had complete pain relief, whereas 2 feet had a lesser degree of persistent metatarsalgia. A review of preoperative and postoperative radiographs showed that the hallux valgus angle improved from a mean 36 degrees preoperatively to 18 degrees postoperatively. Likewise, the mean 1 to 2 intermetatarsal angle improved from 13 degrees to 7.3 degrees. There was no incidence of avascular necrosis. Fourteen patients (16 feet) rated the outcome as excellent, 10 (11 feet) as good, and 1 patient with asymptomatic mild hallux varus deformity rated the result as fair. These results demonstrate that the spike osteotomy is a suitable operation for treatment of mild to moderate hallux valgus.     

Effect of displacement of ulna-shaft fractures on forearm rotation: a cadaveric model

Nonoperative treatment of ulna-shaft fractures may result in healing with residual displacement. In the study reported here, we used a cadaveric model to try to determine whether displacement significantly reduces forearm supination and pronation. Transverse osteotomies were made one third, one half, and two thirds of the distance from the proximal end to the distal end of each of 7 fresh cadaveric forearms. Displacements of 50% and 100% were tested at each osteotomy site. Specimens were mounted on a material-testing machine, and forearm rotation was determined. Supination loss was less than 15 degrees for all directions of displacement at all osteotomy sites. Pronation loss was less than 10 degrees at the distal osteotomy site; at the middle osteotomy site, pronation loss was 19 degrees with 100% radial displacement (P < .05) and 20 degrees with 100% ulnar displacement (P< .05); and, at the proximal osteotomy site, pronation loss was 19 degrees with 50% radial displacement (P < .01), 41 degrees with 100% radial displacement (P < .0005), and 33 degrees with 100% ulnar displacement (P < .005). We conclude that large residual displacement in distal fractures and moderate residual displacement in midshaft fractures do not significantly compromise forearm rotation. Proximal displacement was less tolerated in this model and resulted in significantly reduced forearm rotation.     

Corrective osteotomy of malunited distal radius fractures

The malunion of the distal radius may result in shortening, radial impaction, volar angulation, dorsal displacement or rotatory deformity. For restoration, the anatomy and kinematics of the distal radioulnar joint and the triangular fibrocartilaginous complex (TFCC) are of importance. This nonunion consists of the articular disk, a meniscus homologue, the ulnar collateral ligament, and the dorsal and palmar radioulnar ligaments. Malunion of the distal radioulnar joint leads to an increase in loading on the individual parts, as well as pain and a decrease in supination and pronation. Osteotomy is indicated if the angulation of the malunion is more than 20 degrees in the frontal or sagittal plane. Corrective osteotomy requires detailed preoperative planning with calculation of the correct position in all planes. The most common operation that has proved to be effective is osteotomy of the radius, insertion of a trapezoidal bone graft in place, and internal fixation with a dorsal or volar plate.     

Three-dimensional corrective osteotomy for cubitus varus in adults

In 23 adult patients, cubitus varus deformity was corrected by 3-dimensional osteotomy. During surgery, not only varus but internal rotation, flexion-extension deformity of the elbow, and lateral protrusion of the distal fragment were simultaneously addressed. The mean age of the patients was 26 years. Three showed tardy ulnar nerve palsy. The follow-up period after osteotomy averaged 1 year 10 months. The humeral-elbow-wrist angle improved from a mean 26 degrees of varus preoperatively to a mean of 3 degrees of valgus postoperatively. The mean internal rotation angle improved from 25 degrees to 5 degrees. As there was no recurrence of the deformity, this method of 3-dimensional corrective osteotomy for the treatment of cubitus varus in skeletally mature adults is recommended.     

Abnormal triangular epiphysis causing angular deformity of the thumb

PURPOSE: To present a triangular-shaped abnormal secondary ossification center of the distal phalanx causing angular deformity of the thumb and the surgical outcome of corrective closing-wedge osteotomy for this deformity. METHODS: We treated 6 patients with abnormal triangular epiphysis in the distal phalanx of the thumb, including 3 bilateral cases. The average age was 43 months and there were 2 boys and 4 girls. Of the 9 thumbs intraepiphyseal closing-wedge osteotomy was performed in 5 and proximal phalangeal closing-wedge osteotomy was performed in 4. We measured the deformities in degrees of angulation and the range of motion of the interphalangeal (IP) joint. The average duration of the follow-up period was 27 months after the surgery. RESULTS: Preoperative angular deformity of ulnar deviation averaged 30 degrees , which was reduced to an average of 12 degrees after osteotomy at the last follow-up assessment. All osteotomies healed and there was no evidence of physeal or articular damage. Interphalangeal joint range of motion did not decrease after surgery in all cases. Patients and parents were satisfied with the results of the surgery, although mild deformity persisted in the interphalangeal joint when in the flexed position after proximal phalangeal osteotomy. CONCLUSIONS: Abnormal triangular epiphysis causing angled thumb is different from delta bone and can be treated with either intraepiphyseal or proximal phalangeal closing-wedge osteotomy. The intraepiphyseal procedure, however, could achieve better deformity correction regardless of the interphalangeal joint position. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

Hallux valgus in men. Part II: First ray mobility after bunionectomy and factors associated with hallux valgus deformity

PURPOSE: To determine the 1st ray mobility following a distal soft-tissue procedure with proximal osteotomy (DSTP-PMO) and any associated factors. METHODS: A retrospective study of 30 men (35 feet) was performed. First ray mobility, ankle dorsiflexion, pes planus, and metatarsus adductus were evaluated at the final follow-up. All internal fixation was routinely removed at six to eight weeks postoperatively. Standard radiographs were evaluated and angular measurements were calculated on all feet. RESULTS: The mean follow-up was 78 months. No cases of degenerative arthritis of the 1st MTC joint were noted on follow-up radiographs. DSTP-PMO resulted in a mean postoperative 1st ray mobility of 4.9 mm (range, 2.5 to 8). In those feet evaluated following bunion correction, there was no correlation with pes planus, limited ankle dorsiflexion or metatarsus adductus. The preoperative hallux valgus angle and 1-2 intermetatarsal angle correlated with toe pronation and a positive family history. Twenty-two patients had an AOFAS score of 90-100, seven of 80-89 and one less than 69. CONCLUSION: Hallux valgus in this group of male patients was not associated with limited ankle dorsiflexion or pes planus. Men with toe pronation and a positive family history had a greater hallux valgus deformity than those without after a distal soft tissue repair with proximal first metatarsal osteotomy. There was no evidence of first ray hypermobility after a DSTP-PMO.     

Effect of increasing distal medial closing wedge metatarsal osteotomies on the distal metatarsal articular angle

The recognition, definition, and management of the congruent hallux valgus deformity continue to evolve. To correct the skeletal deformity and maintain joint congruity, many authors have emphasized the importance of extra-articular procedures. One such procedure is a distal medial closing wedge osteotomy of the first metatarsal. Unfortunately, there are few guidelines to help determine the pre- and intraoperative size of the medial wedge to obtain the desired correction of the distal metatarsal articular angle (DMAA). The purpose of this study was to quantify the effects of increasing distal medial closing wedge osteotomies on the DMAA in an in vitro cadaver model. In this study, a closing wedge osteotomy was performed 2 cm proximal to the articular surface, removing wedges measuring 2 mm, 4 mm, and 6 mm in width. The mean preoperative DMAA was 8.5 degrees, and the mean postoperative DMAAs after 2-mm, 4-mm, and 6-mm closing wedge osteotomies were -2.6 degrees, -10.2 degrees, and -20.2 degrees, respectively. The data showed that for every 1 mm of closing wedge osteotomy, the DMAA decreased by 4.7 degrees +/- 0.6 degrees. These results can be used for pre- and intraoperative planning when surgically correcting a congruent hallux valgus deformity with a distal medial closing wedge osteotomy of the first metatarsal. Additional information obtained from this cadaver study includes (1) increased shortening of the first metatarsal and (2) incongruity produced at the joint after the medial-based osteotomy. The amount of shortening of the first metatarsal correlated directly with the size of the medial-based wedge. The second point indicates that a lateral soft-tissue release may still be required when using this method of reorienting the DMAA.     

Supracondylar humeral osteotomy in children with severe posttraumatic cubitus varus deformity

The authors report the results of corrective osteotomy of the humerus in 11 children with severe posttraumatic cubitus varus deformity. The average carrying angle on the affected side was -24.4 degrees, and there was an average internal rotation deformity of the distal humerus of 22 degrees. Flexion and extension of the injured elbow were severely limited. A supracondylar lateral wedge osteotomy of the humerus was performed keeping the medial cortex intact. Two K-wires served as levers to correct the angular and rotational deformity of the elbow and then as fixation material to hold the osteotomy fragments. Postoperatively we immobilized the elbows in 90 degrees flexion for 3 to 4 weeks. There was no loss of the postoperative osteotomy alignment in most cases. Recurrence of mild varus deformity (-5 degrees and -7 degrees) occurred in only two patients. At the end of the follow-up we observed excellent results in 9 patients with an average carrying angle of 7.2 degrees (range 5-10 degrees).     

股骨远端内翻截骨加交锁髓内钉固定治疗膝外翻畸形

目的　探讨股骨远端内翻截骨加交锁髓内钉固定 ,治疗伴有膝外翻畸形的膝关节骨性关节炎的疗效。方法　 1996年 5月～ 2 0 0 0年 8月 ,采用股骨远端内翻截骨加交锁髓内钉固定治疗 16例 (16膝 )伴膝外翻畸形的膝关节骨性关节炎 ,病程 1～ 2 1年 ,平均 5 .2年。按 Ahlback分类 度 10例 , 度 6例。股骨髁上截骨 11例 ,股骨干远端截骨 5例。术前、术后 8周和 2年均行患肢全长 X线片检查 ,以测量股胫角、胫骨角、股骨角及胫股关节面切线夹角及胫股外侧间距大小。按膝关节功能评定标准 ,评定术后膝关节功能恢复情况。　结果　 16例术后获随访 2 5～ 4 6个月 ,平均 31个月。术后 2年随访骨愈合满意 ,1例延迟愈合 ,为股骨干远端截骨患者。皮肤感染 1例。膝关节功能自 5 0 .4± 15 .9分增至 78.5± 12 .9分 ,胫股关节面切线夹角自 5 .6± 2 .9°减少至 1.6± 3.4°,胫股外侧关节间距自 2 .1± 1.8mm增至 4 .7±1.7m m。　结论　股骨远端内翻截骨加交锁髓内钉内固定 ,可作为治疗伴有膝外翻畸形的膝关节骨性关节炎的有效方法之一。     

Transpedicular wedge osteotomy for correction of thoracolumbar kyphosis in ankylosing spondylitis: experience with 78 patients

STUDY DESIGN: This is a retrospective study of surgical correction of thoracolumbar kyphosis caused by ankylosing spondylitis. OBJECTIVE: To report the surgical results of thoracolumbar kyphosis deformity corrected with transpedicular wedge osteotomy performed by a single surgeon at a university hospital. SUMMARY OF BACKGROUND DATA: There has not been a large series in the literature reporting on results of the Thomasen-type closing wedge osteotomy for correction of kyphosis deformity secondary to ankylosing spondylitis, nor has two-level osteotomy of this type in one patient ever been described. METHODS: From 1991 through 1998, 92 transpedicular wedge osteotomies were performed in 78 patients with ankylosing spondylitis for correction of fixed flexion deformity of the thoracolumbar spine. RESULTS: The mean amount of correction for each level of osteotomy was 34.5 degrees (range, 15 degrees -60 degrees ). The largest amount of overall correction for a single patient was 100 degrees. Most of the osteotomies (64 of 92) were done at L2 and L3. Fourteen patients with severe deformity required staged two-level osteotomy. Excellent and good results were obtained in 77 patients (98.7%) at the final follow-up. There was no mortality, nor were there any major neurological complications. CONCLUSIONS: Transpedicular wedge osteotomy can effectively and safely correct kyphotic deformity of the thoracolumbar spine caused by ankylosing spondylitis, regardless of rigidity of the spinal curves. Two-level osteotomy can provide sufficient correction for severe cases.