Abstract：
BACKGROUND: Ankylosing Spondylitis (AS) patients with acute spinal fractures represent a challenge for practicing spine surgeons due to difficult operative anatomy and susceptibility to complications.
OBJECTIVE: Does intraoperative CT-navigation improve outcomes in patients with ankylosing spondylitis undergoing surgery?
METHODS: A retrospective review was carried out at our centre from 05/2016-06/2021 to identify AS patients presenting with a traumatic spinal fracture, managed surgically with posterior spinal fusion (PSF). Cohorts were categorised and compared for outcomes based on those who underwent PSF with intraoperative CT-navigation versus those surgically managed with traditional intraoperative fluoroscopy.
RESULTS: 37 AS patients were identified. 29/37 (78.4%) underwent PSF. Intraoperative navigation was used in 14 (48.3%) cases. Mean age of the entire cohort was 67.6 years. No difference existed between the navigated and non-navigated groups for mean levels fused (5.35 vs 5.07; p = 0.31), length of operation (217.9mins vs 175.3mins; p = 0.07), overall length-of-stay (12 days vs 21.9 days; p = 0.16), patients requiring HDU (3/14 vs 5/15; p = 0.09) or ICU (5/14 vs 9/15; p = 0.10), postoperative neurological improvement (1/14 vs 1/15; p = 0.48) or deterioration (1/14 vs 0/15; p = 0.15), intraoperative complications (2/14 vs 3/15; p = 0.34), postoperative complications 4/14 vs 4/15; p = 0.46), revision surgeries (3/14 vs 1/15; p = 0.16) and 30-day mortality (0/14 vs 0/15).
CONCLUSIONS: This is the first study that compares surgical outcomes of navigated vs non-navigated PSFs for AS patients with an acute spinal fracture. Although limited by its retrospective design and sample size, this study highlights the non-inferiority of intraoperative navigation as a surgical aid in a challenging cohort.
OBJECTIVE: Does intraoperative CT-navigation improve outcomes in patients with ankylosing spondylitis undergoing surgery?
METHODS: A retrospective review was carried out at our centre from 05/2016-06/2021 to identify AS patients presenting with a traumatic spinal fracture, managed surgically with posterior spinal fusion (PSF). Cohorts were categorised and compared for outcomes based on those who underwent PSF with intraoperative CT-navigation versus those surgically managed with traditional intraoperative fluoroscopy.
RESULTS: 37 AS patients were identified. 29/37 (78.4%) underwent PSF. Intraoperative navigation was used in 14 (48.3%) cases. Mean age of the entire cohort was 67.6 years. No difference existed between the navigated and non-navigated groups for mean levels fused (5.35 vs 5.07; p = 0.31), length of operation (217.9mins vs 175.3mins; p = 0.07), overall length-of-stay (12 days vs 21.9 days; p = 0.16), patients requiring HDU (3/14 vs 5/15; p = 0.09) or ICU (5/14 vs 9/15; p = 0.10), postoperative neurological improvement (1/14 vs 1/15; p = 0.48) or deterioration (1/14 vs 0/15; p = 0.15), intraoperative complications (2/14 vs 3/15; p = 0.34), postoperative complications 4/14 vs 4/15; p = 0.46), revision surgeries (3/14 vs 1/15; p = 0.16) and 30-day mortality (0/14 vs 0/15).
CONCLUSIONS: This is the first study that compares surgical outcomes of navigated vs non-navigated PSFs for AS patients with an acute spinal fracture. Although limited by its retrospective design and sample size, this study highlights the non-inferiority of intraoperative navigation as a surgical aid in a challenging cohort.
摘要：
背景：患有急性脊柱骨折的强直性脊柱炎（AS）患者由于手术解剖困难和容易发生并发症，对从事脊柱外科医生来说是一个挑战。
目的：术中CT导航是否能改善强直性脊柱炎手术患者的预后？
方法：我们中心于2016年5月6日-2021年6月进行了回顾性研究，以确定患有创伤性脊柱骨折的AS患者，通过后路脊柱融合术（PSF）进行手术管理。根据术中CT导航PSF与传统术中透视手术管理的患者对队列进行分类和比较。
结果：确定了37例AS患者。29/37（78.4%）接受PSF。术中导航14例(48.3%)。整个队列的平均年龄为67.6岁。导航组和非导航组的平均水平融合没有差异(5.35vs5.07;p=0.31)，手术时间（217.9分钟vs175.3分钟；p=0.07），总住院时间(12天vs21.9天；p=0.16)，需要HDU（3/14vs5/15；p=0.09）或ICU（5/14vs9/15；p=0.10）的患者，术后神经系统改善（1/14vs1/15；p=0.48）或恶化（1/14vs0/15；p=0.15），术中并发症（2/14vs3/15；p=0.34），术后并发症4/14vs4/15；p=0.46)，翻修手术（3/14vs1/15；p=0.16）和30天死亡率（0/14vs0/15）。
结论：这是第一项比较急性脊柱骨折AS患者的导航PSF与非导航PSF手术结果的研究。尽管受限于其回顾性设计和样本量，这项研究强调了在一个具有挑战性的队列中,术中导航作为手术辅助的非劣效性.
目的：术中CT导航是否能改善强直性脊柱炎手术患者的预后？
方法：我们中心于2016年5月6日-2021年6月进行了回顾性研究，以确定患有创伤性脊柱骨折的AS患者，通过后路脊柱融合术（PSF）进行手术管理。根据术中CT导航PSF与传统术中透视手术管理的患者对队列进行分类和比较。
结果：确定了37例AS患者。29/37（78.4%）接受PSF。术中导航14例(48.3%)。整个队列的平均年龄为67.6岁。导航组和非导航组的平均水平融合没有差异(5.35vs5.07;p=0.31)，手术时间（217.9分钟vs175.3分钟；p=0.07），总住院时间(12天vs21.9天；p=0.16)，需要HDU（3/14vs5/15；p=0.09）或ICU（5/14vs9/15；p=0.10）的患者，术后神经系统改善（1/14vs1/15；p=0.48）或恶化（1/14vs0/15；p=0.15），术中并发症（2/14vs3/15；p=0.34），术后并发症4/14vs4/15；p=0.46)，翻修手术（3/14vs1/15；p=0.16）和30天死亡率（0/14vs0/15）。
结论：这是第一项比较急性脊柱骨折AS患者的导航PSF与非导航PSF手术结果的研究。尽管受限于其回顾性设计和样本量，这项研究强调了在一个具有挑战性的队列中,术中导航作为手术辅助的非劣效性.
