Background: This study aimed to compare Smith-Petersen osteotomy (SPO), poly-segmental wedge osteotomy\n(PWO) and pedicular subtraction osteotomy (PSO) in patients with rigid thoracolumbar kyphosis primarily caused\nby ankylosing spondylitis. The efficiency, efficacy and safety of these three osteotomies have not been compared\nsystematically, and no illness-oriented surgical type selection strategy for the treatment of ankylosing spondylitis\nrelated to non-angular kyphosis has been reported.\nMethods: The inclusion and exclusion criteria were defined, and 19 electronic databases were searched for eligible\nstudies without language limitations. For the included studies, data extraction, bias analysis, heterogeneity\nanalysis and quantitative analysis were performed to analyze the correction of kyphosiskyphosis and the\nincidence of complications.\nResults: Nine comparative studies that met the standards were included with a total of 539 patients that\nunderwent SPO (n = 120), PWO (n = 119), or PSO (n = 300). The correction of kyphosis by PSO was 8.74�°\n[95 % CI: 0.7-16.78] greater than SPO. The correction of kyphosis by PWO was 13.88�° [95 % CI: 9.25-18.51]\ngreater than SPO. For local biomechanical complications, the pooled risk ratio of PWO to PSO was 1.97\n[95 % CI: 1.03-3.77]. For blood loss, PSO was 806.42 ml [95 % CI: 591.72-1021.12] greater than SPO and\n566.76 ml [95 % CI: 129.80-1003.72] greater than PWO.\nConclusions: To treat rigid thoracolumbar kyphosis, PSO showed higher efficiency and efficacy than SPO, and\nPWO had a higher efficacy than SPO. The risk of local biomechanical complications was greater in PWO than\nPSO. Bleeding was more severe in PSO than in SPO or PWO. The incidence of neural complications and\nsystemic complications was similar.
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