Surgical Techniques for Ankylosing Spondylitis Patients with Thoracolumbar Fractures: A Systematic Review and Meta-analysis

Introduction: Ankylosing spondylitis (AS) patients with thoracolumbar fractures face heightened challenges in surgical management due to unique anatomical rigidity and potential spinal deformities. Optimizing surgical techniques is critical for effective stabilization, pain management, and functional recovery. This systematic review and meta-analysis examine the effectiveness and safety of various surgical interventions in AS patients with thoracolumbar fractures.

Methods: A systematic review of studies published from 2010 to 2023 was conducted following PRISMA guidelines, focusing on surgical interventions in AS patients with thoracolumbar fractures. We included studies that reported on posterior fixation, anterior-only, combined approaches, and minimally invasive techniques. Meta-analysis was performed using R, analyzing outcomes such as postoperative kyphosis correction, complication rates, and functional recovery (measured by the Oswestry Disability Index (ODI) and American Spinal Injury Association (ASIA) scores). Forest plots and risk ratios were generated using Python.

Results: Data from 15 studies, totaling 560 patients, were included. Posterior-only fixation emerged as the most commonly applied technique, with improved alignment and a mean kyphosis correction of 13° (p < 0.05). Combined approaches (anterior-posterior fixation) demonstrated superior kyphosis correction (mean improvement of 17°) but were associated with higher blood loss and operative time. Minimally invasive techniques showed lower complication rates, including infection, but had limited kyphosis correction. ASIA and ODI scores indicated moderate functional improvements across techniques, with combined approaches showing slightly better recovery in cases of severe deformity.

Conclusion : Surgical techniques for AS-related thoracolumbar fractures require a tailored approach based on fracture stability, kyphotic angle, and patient condition. Posterior-only fixation remains effective for moderate deformities, while combined approaches may be advantageous for more severe cases despite higher complication risks. Minimally invasive methods offer a safer option in select patients. Standardized guidelines for AS patients with thoracolumbar fractures could aid in clinical decision-making and improve patient outcomes.