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Abstract：
BACKGROUND: Spinal fractures in patients with ankylosing spondylitis (AS) mainly present as instability, involving all three columns of the spine, and surgical intervention is often considered necessary. However, in AS patients, the significant alterations in bony structure and anatomy result in a lack of identifiable landmarks, which increases the difficulty of pedicle screw implantation. Therefore, we present the clinical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with AS.
METHODS: A retrospective review was conducted on a series of 12 patients diagnosed with AS. All patients sustained thoracolumbar fractures between October 2018 and October 2022 and underwent posterior robotic-assisted percutaneous fixation procedures. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union. The clinical outcomes were assessed using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). To investigate the achieved operative correction, pre- and postoperative radiographs in the lateral plane were analyzed by measuring the Cobb angle.
RESULTS: The 12 patients had a mean age of 62.8 ± 13.0 years and a mean follow-up duration of 32.7 ± 18.9 months. Mean hospital stay duration was 15 ± 8.0 days. The mean operative time was 119.6 ± 32.2 min, and the median blood loss was 50 (50, 250) ml. The VAS value improved from 6.8 ± 0.9 preoperatively to 1.3 ± 1.0 at the final follow-up (P < 0.05). The ODI value improved from 83.6 ± 6.1% preoperatively to 11.8 ± 6.6% at the latest follow-up (P < 0.05). The average Cobb angle changed from 15.2 ± 11.0 pre-operatively to 8.3 ± 7.1 at final follow-up (P < 0.05). Bone healing was consistently achieved, with an average healing time of 6 (5.3, 7.0) months. Of the 108 screws implanted, 2 (1.9%) were improperly positioned. One patient experienced delayed nerve injury after the operation, but the nerve function returned to normal upon discharge.
CONCLUSIONS: Posterior robotic-assisted percutaneous internal fixation can be used as an ideal surgical treatment for thoracolumbar fractures in AS patients. However, while robot-assisted pedicle screw placement can enhance the accuracy of pedicle screw insertion, it should not be relied upon solely.
METHODS: A retrospective review was conducted on a series of 12 patients diagnosed with AS. All patients sustained thoracolumbar fractures between October 2018 and October 2022 and underwent posterior robotic-assisted percutaneous fixation procedures. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union. The clinical outcomes were assessed using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). To investigate the achieved operative correction, pre- and postoperative radiographs in the lateral plane were analyzed by measuring the Cobb angle.
RESULTS: The 12 patients had a mean age of 62.8 ± 13.0 years and a mean follow-up duration of 32.7 ± 18.9 months. Mean hospital stay duration was 15 ± 8.0 days. The mean operative time was 119.6 ± 32.2 min, and the median blood loss was 50 (50, 250) ml. The VAS value improved from 6.8 ± 0.9 preoperatively to 1.3 ± 1.0 at the final follow-up (P < 0.05). The ODI value improved from 83.6 ± 6.1% preoperatively to 11.8 ± 6.6% at the latest follow-up (P < 0.05). The average Cobb angle changed from 15.2 ± 11.0 pre-operatively to 8.3 ± 7.1 at final follow-up (P < 0.05). Bone healing was consistently achieved, with an average healing time of 6 (5.3, 7.0) months. Of the 108 screws implanted, 2 (1.9%) were improperly positioned. One patient experienced delayed nerve injury after the operation, but the nerve function returned to normal upon discharge.
CONCLUSIONS: Posterior robotic-assisted percutaneous internal fixation can be used as an ideal surgical treatment for thoracolumbar fractures in AS patients. However, while robot-assisted pedicle screw placement can enhance the accuracy of pedicle screw insertion, it should not be relied upon solely.
摘要：
背景：强直性脊柱炎（AS）患者的脊柱骨折主要表现为不稳定，涉及脊柱的所有三列，手术干预通常被认为是必要的。然而,在AS患者中，骨结构和解剖结构的显著改变导致缺乏可识别的地标，增加了椎弓根螺钉植入的难度。因此,我们介绍了机器人辅助经皮内固定治疗AS患者胸腰椎骨折的临床疗效.
方法：对12例确诊为AS的患者进行了回顾性分析。所有患者在2018年10月至2022年10月期间均患有胸腰椎骨折，并接受了后路机器人辅助经皮内固定手术。感兴趣的结果包括手术时间，术中失血,并发症,住院时间和骨折愈合。使用视觉模拟评分（VAS）和Oswestry残疾指数（ODI）评估临床结果。为了调查已实现的手术矫正，通过测量Cobb角分析术前和术后侧面的X光片。
结果：12例患者的平均年龄为62.8±13.0岁，平均随访时间为32.7±18.9个月。平均住院时间为15±8.0天。平均手术时间119.6±32.2min,中位失血量为50(50,250)ml。VAS值从术前的6.8±0.9提高到末次随访时的1.3±1.0(P<0.05)。ODI值从术前的83.6±6.1％提高到最新随访的11.8±6.6％（P<0.05）。平均Cobb角由术前的15.2±11.0变为末次随访的8.3±7.1(P<0.05)。骨愈合始终如一，平均愈合时间为6（5.3，7.0）个月。在植入的108颗螺钉中，2（1.9%）定位不当。一名患者术后出现迟发性神经损伤,但出院后神经功能恢复正常.
结论：后路机器人辅助经皮内固定可作为治疗AS患者胸腰椎骨折的理想手术方法。然而,而机器人辅助椎弓根螺钉的放置可以提高椎弓根螺钉插入的准确性，不应该仅仅依靠它。
方法：对12例确诊为AS的患者进行了回顾性分析。所有患者在2018年10月至2022年10月期间均患有胸腰椎骨折，并接受了后路机器人辅助经皮内固定手术。感兴趣的结果包括手术时间，术中失血,并发症,住院时间和骨折愈合。使用视觉模拟评分（VAS）和Oswestry残疾指数（ODI）评估临床结果。为了调查已实现的手术矫正，通过测量Cobb角分析术前和术后侧面的X光片。
结果：12例患者的平均年龄为62.8±13.0岁，平均随访时间为32.7±18.9个月。平均住院时间为15±8.0天。平均手术时间119.6±32.2min,中位失血量为50(50,250)ml。VAS值从术前的6.8±0.9提高到末次随访时的1.3±1.0(P<0.05)。ODI值从术前的83.6±6.1％提高到最新随访的11.8±6.6％（P<0.05）。平均Cobb角由术前的15.2±11.0变为末次随访的8.3±7.1(P<0.05)。骨愈合始终如一，平均愈合时间为6（5.3，7.0）个月。在植入的108颗螺钉中，2（1.9%）定位不当。一名患者术后出现迟发性神经损伤,但出院后神经功能恢复正常.
结论：后路机器人辅助经皮内固定可作为治疗AS患者胸腰椎骨折的理想手术方法。然而,而机器人辅助椎弓根螺钉的放置可以提高椎弓根螺钉插入的准确性，不应该仅仅依靠它。
