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Background <p>ankylosing spondylitis related subaxial cervical fracture-dislocations (ASCF) are highly unstable, frequently traverse the three columns, and often occur at the disc level, leading to substantial neurological risk. Optimal surgical approach—anterior, posterior, or combined 360° fixation—remains debated, particularly when long-segment (≥ 4 levels) stabilization is required.</p> Methods <p>This two-center retrospective cohort included 162 consecutive AS patients with subaxial cervical (C3–C7) fracture–dislocations treated from January 2014 to December 2023. Patients underwent either a modified anterior long-segment fixation (anterior group, <i>n</i> = 66), long-segment posterior fixation (posterior group, <i>n</i> = 54), or combined anterior–posterior fixation (combined group, <i>n</i> = 42). The modified anterior technique was defined as an anterior construct spanning 4 vertebral levels, incorporating temporary screw compression and multiplanar divergent screw trajectories to enhance stability. Primary outcomes were operative time, intraoperative blood loss, fracture union time, and complication rate. Radiographic stability and neurological status (Frankel grade) were assessed at final follow-up.</p> Results <p>Mean follow-up was 33.6 ± 11.8 months (range, 12–58). The modified anterior approach demonstrated significantly shorter operative time (103.1 ± 16.6&#xa0;min), less blood loss (92.7 ± 27.2 mL), and a lower overall complication rate (9.1%) compared to posterior and combined approaches (all <i>P</i> &lt; 0.05). Fracture healing time was prolonged in the posterior group (5.3 ± 1.1 months) versus anterior (3.8 ± 1.1) and combined (4.0 ± 1.4) groups (<i>P</i> &lt; 0.001). All groups showed significant neurological improvement (<i>P</i> &lt; 0.001) with no intergroup differences in final Frankel grade (<i>P</i> = 0.327). No implant failure was observed.</p> Conclusions <p>For ASCF requiring long-segment fixation, a modified anterior approach confers shorter operative time, reduced blood loss, accelerated fracture healing, and fewer complications compared with posterior or combined surgery, while achieving similar radiographic stability and neurological recovery. However, differences in baseline injury severity and non-randomized approach selection introduce potential confounding by indication.</p>

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Modified anterior long-segment fixation versus posterior and combined approaches for subaxial cervical fractures in ankylosing spondylitis: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年4月13日

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  • Xiuzhi Li,
  • Yuan Cao,
  • Zengzhen Cui,
  • Yuliang Fu,
  • Liangyu Bai,
  • Zhuoqi Wei,
  • Xiaoyu Norman Pan,
  • Yuwei Li,
  • Yang Lv

摘要

Background

ankylosing spondylitis related subaxial cervical fracture-dislocations (ASCF) are highly unstable, frequently traverse the three columns, and often occur at the disc level, leading to substantial neurological risk. Optimal surgical approach—anterior, posterior, or combined 360° fixation—remains debated, particularly when long-segment (≥ 4 levels) stabilization is required.

Methods

This two-center retrospective cohort included 162 consecutive AS patients with subaxial cervical (C3–C7) fracture–dislocations treated from January 2014 to December 2023. Patients underwent either a modified anterior long-segment fixation (anterior group, n = 66), long-segment posterior fixation (posterior group, n = 54), or combined anterior–posterior fixation (combined group, n = 42). The modified anterior technique was defined as an anterior construct spanning 4 vertebral levels, incorporating temporary screw compression and multiplanar divergent screw trajectories to enhance stability. Primary outcomes were operative time, intraoperative blood loss, fracture union time, and complication rate. Radiographic stability and neurological status (Frankel grade) were assessed at final follow-up.

Results

Mean follow-up was 33.6 ± 11.8 months (range, 12–58). The modified anterior approach demonstrated significantly shorter operative time (103.1 ± 16.6 min), less blood loss (92.7 ± 27.2 mL), and a lower overall complication rate (9.1%) compared to posterior and combined approaches (all P < 0.05). Fracture healing time was prolonged in the posterior group (5.3 ± 1.1 months) versus anterior (3.8 ± 1.1) and combined (4.0 ± 1.4) groups (P < 0.001). All groups showed significant neurological improvement (P < 0.001) with no intergroup differences in final Frankel grade (P = 0.327). No implant failure was observed.

Conclusions

For ASCF requiring long-segment fixation, a modified anterior approach confers shorter operative time, reduced blood loss, accelerated fracture healing, and fewer complications compared with posterior or combined surgery, while achieving similar radiographic stability and neurological recovery. However, differences in baseline injury severity and non-randomized approach selection introduce potential confounding by indication.