Abstract

BACKGROUND CONTEXT Ankylosing spondylitis (AS) is a quite common disease in both China and the United States with a reported indidence of 0.13-0.23%. The incidence of fracture in AS patients is higher compared with the ordinary population. Thoracolumbar fractures are the most common type with some complications. Treatment is usually focused on restoration of spinal stability because of the unique character of the AS spine. Surgical treatment is the primary treatment method and percutaneous fixation could be a minimally invasive option for most patients. PURPOSE To observe the clinical effect of thoracolumbar fracture of AS treated with posterior percutaneous long-segment internal fixation in 21 patients. STUDY DESIGN/SETTING Forty-one patients were divided into (1) a percutaneous group (21) and (2) an open surgery group (20). Posterior long-segment internal fixation with rod and screws was randomized and performed either openly or percutaneously. General data of the two groups were compared before the surgery and other parameters were compared during and after the surgery. SPSS 20 was used for statistics and P PATIENT SAMPLE Forty-one patients were included in the study. OUTCOME MEASURES Operating time, blood loss during surgery, misplacement of screws, bed rest time after operation and VAS were measured. METHODS Forty-one patients diagnosed with thoracolumbar fractures of AS were treated from Nov. 2014 to Nov. 2018. All patients were divided into a percutaneous group and an open surgery group by means of a random table. Twenty patients underwent open fixation with long-segment screws and 21 others treated with percutaneous long-segment internal fixation. Reduction was performed with positioning and manipulation before sterilization. Small incisions were made according to the preoperation plan and then screws were inserted under fluorscopy. The rod must be shaped beforehand and then put into position. Operating time, blood loss, misplacement of pedicle screws and length of bed rest after operation were recorded. Imaging examinations were performed to evaluate the bone union, spinal cord injury and spinal column balance during follow up. RESULTS All patients, followed up for 6 to 48 months (mean time 21.7 months), showed bony union and no signs of loosening or broken rods or screws. During surgery, there were no displaced screws or nerve injuries. No infections were found during or after the surgery; all surgical wounds healed. Significant differences were found for operating time, blood loss during the operation and length of bed rest after surgery within the two groups (P 0.05). CONCLUSIONS As a minimally invasive surgery, posterior percutaneous long-segment internal fixation can achieve results similar to traditional open surgery in relieving patients’ pain and correcting spinal kyphosis with less operating time, less blood loss during operation and less traumatic impact. It could be considered the first choice or a comparatively ideal method for the treatment of thoracolumbar fractures of AS patients. 3D print technique could be used for helping reduction and shaping of the rod. FDA DEVICE/DRUG STATUS percutaneous fixation system (Approved for this indication).

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