Comparison of Posterior Approach and Combined Anterior-Posterior Approach in the Treatment of Ankylosing Spondylitis Combined With Cervical Spine Fracture: A Systematic Review and Meta-Analysis

Global Spine Journal, 2024 · DOI: 10.1177/21925682231224393 · Published: May 1, 2024

Neurology Surgery Musculoskeletal Medicine

Simple Explanation

Ankylosing spondylitis (AS) is a chronic inflammatory disease that can lead to spinal fractures. This study compares two surgical approaches for treating AS patients with cervical spine fractures: the posterior approach and the combined anterior-posterior approach. The study analyzes data from multiple previous studies to determine which surgical approach leads to better outcomes for patients with AS and cervical spine fractures. The researchers looked at factors like operation time, blood loss during surgery, neurological improvement, complication rates, and mortality rates to compare the effectiveness of the two surgical approaches.

Study Duration

Until August 2023

Participants

215 patients (108 posterior approach, 107 combined anterior-posterior approach)

Evidence Level

Systematic Review and Meta-Analysis of 11 retrospective cohort studies

Key Findings

1
The posterior approach resulted in significantly less intraoperative blood loss compared to the combined approach.
2
The posterior approach had a significantly shorter operation time compared to the combined anterior-posterior approach.
3
There were no statistically significant differences in neurological improvement rates, complication rates, revision surgery rates, or mortality rates between the two approaches.

Research Summary

This meta-analysis compared the posterior approach and combined anterior-posterior approach for treating ankylosing spondylitis (AS) patients with cervical spine fractures. The posterior approach was associated with less intraoperative blood loss and shorter operation times, but no significant differences were found in neurological outcomes, complications, revision surgeries, or mortality. The study concludes that both approaches can achieve good results, and clinicians should individualize their approach based on patient-specific factors like fracture type, spinal cord injury severity, and overall health.

Practical Implications

Surgical Approach Selection

Surgeons can consider the posterior approach for AS patients with cervical fractures to minimize blood loss and operation time, especially in patients with cardiopulmonary issues.

Individualized Treatment

Treatment plans should be tailored to the specific patient's condition, considering fracture characteristics, neurological status, and overall health.

Further Research

Future studies with larger patient cohorts and prospective designs are needed to further validate these findings and identify specific patient subgroups that may benefit more from one approach over the other.

Study Limitations

1
All articles included in this study were retrospective cohort studies and the number of patients included was small.
2
Information about patients’ preoperative underlying cardiopulmonary disease in the included literature, was not documented.
3
More cases and prospective or multicenter studies may yield more convincing results.

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