Posterior treatment of ankylosing spinal diseases with thoracolumbar fractures: a network meta-analysis

The implementation of diverse surgical techniques plays a crucial role in managing ankylosing spinal diseases (ASDs), serving as invaluable tools. Presently, posterior surgery stands out as the predominant approach owing to its familiarity with anatomical structures; however, it comprises various methodologies that require a thorough comprehension for their suitable application. Henceforth, we performed a network meta-analysis to assess and prioritize the efficacy and safety of surgical interventions for ASDs.

The databases PubMed, EMBASE, Cochrane Library, and CNKI (China National Knowledge Infrastructure) were systematically searched for both randomized and non-randomized studies. No restrictions were placed on the initial time periods or languages of the searches. Patients with thoracolumbar fractures accompanied by ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis were included in this study. RevMan 5.4 and Stata 14.2 software programs were utilized for assessing literature quality and conducting data analysis.

A total of 20 trials involving 1116 patients with ASDs were included, encompassing 4 posterior approaches. Network meta-analysis revealed that Percutaneous puncture demonstrated favorable outcomes in terms of surgical duration, intraoperative blood loss, postoperative bed rest time, and hospital stay. Both percutaneous internal fixation and 3D assisted fixation exhibited alternating advantages in postoperative functional recovery.

Based on the available evidence, it is evident that percutaneous instrumentation offers clear advantages over other forms of instrumentation. However, the quality of some studies is suboptimal and further high-quality randomized controlled trials are necessary to provide additional verification.