Ankylosing Spondylitis (AS), Spine Fracture
Conditions
Keywords
Ankylosing Spondylitis, Cervical fracture and dislocation, anterior internal fixation and fusion, posterior internal fixation and fusion
Brief summary
The purpose of this retrospective cohort study was to observe and compare the efficacy of anterior cervical long segment fixation, posterior long segment fixation, and combined anterior and posterior fixation for the treatment of cervical vertebral fracture-dislocations in the lower cervical spine in ankylosing spondylitis.
Detailed description
This was a retrospective cohort study. Patients operated for fracture-dislocation of the lower cervical vertebrae in ankylosing spondylitis in our hospital from 01/2014 to 01/2024 were retrospectively included as study subjects. Prior to the start of the study, an application will be made for approval through the hospital ethical committee, and the Declaration of Helsinki will be observed during the course of the study. The patients were divided into an anterior group (anterior long-segment cervical fixation), a posterior group (posterior long-segment cervical fixation), and a combined group (combined anterior and posterior fixation) according to the surgical access. The operation time, bleeding, complication occurrence, fracture healing and changes in neurological function of the three groups were compared. In this study, Frankel grading before and after surgery was used as the primary observation index, and operation time, intraoperative bleeding, occurrence of complications, and cervical fracture healing were used as the secondary observation index. SPSS 26.0 (IBM, New York, NY, USA) was applied for statistical analysis in this study.
Interventions
PROCEDUREanterior long segment cervical fixation
PROCEDUREposterior long segment cervical fixation
PROCEDUREcombined anterior and posterior fixation
Sponsors
Luohe Central Hospital
Zhou Fang
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
Meet the diagnostic criteria for ankylosing spondylitis, imaging showed that cervical ankylosing and fracture dislocation of the lower cervical vertebrae (cervical 3\ 7); Age 18\ 80 years old; undergo anterior, posterior or combined access internal fixation surgery and the fixation segment is ≥4 segments.
Exclusion criteria
Systemic or local infection; Previous history of cervical vertebrae surgery; Postoperative loss of follow-up.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| complications | 1, 3, 6, and 12 months after the surgery at the final follow-up | Categorized by the Clavien-Dindo classification system. Documented events include: Intraoperative: Dural tear, vertebral artery injury, nerve root injury. Postoperative (within 30 days): Surgical site infection, implant failure (screw loosening/breakage), cerebrospinal fluid leakage, dysphagia (anterior approach group), adjacent segment degeneration. |
| Radiographic Union Rate Assessed by X-ray and CT Criteria | 1, 2, 3, 6, and 12 months after the surgery at the final follow-up | X-ray union: Fracture line blurring with callus formation ≥50% of fracture area on anteroposterior/lateral views. CT union: Complete fracture line disappearance with continuous callus bridging on thin-slice (≤1 mm) CT reconstructions. |
| Frankel Grade Improvement Rate and Neurological Recovery Index | 1, 3, 6, and 12 months after the surgery at the final follow-up | Assessment tool: Frankel Spinal Cord Injury Scale (A: complete paralysis; B: sensory preservation only; C: non-functional motor preservation; D: functional motor preservation; E: normal function). Improvement rate: Defined as ≥1-grade improvement from baseline, reported as frequency (percentage). Recovery index: Calculated by assigning numerical values (A=1 to E=5), with differences between preoperative and final grades expressed as mean ± SD. Severe injury recovery: Proportion of patients with preoperative Frankel B/C grades achieving D/E grades postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Operative time | immediately after surgery | Defined as the duration from skin incision to wound closure (minutes). Data will be presented as mean ± standard deviation (SD) and compared among anterior, posterior, and combined approach groups. |
| Intraoperative blood loss: | immediately after surgery | Calculated using suction drainage volume combined with gauze weight measurement (1 g ≈ 1 mL). Reported as median (range) and mean ± SD. |
Countries
China
Outcome results
None listed