Minimally invasive fixation of thoracolumbar fractures in ankylosing spondylitis reduces operative time and blood lossMinimally Invasive Surgery Shows Benefits for Ankylosing Spondylitis Fractures

Clinical spine surgery Published August 3, 2026 Study authors: Anaspure Omkar S, Patel Shiv, Newsom Andrew, Baumann Anthony N, Anaspure Aryan S, Goodman Susan M, M… PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider minimally invasive fixation for ankylosing spondylitis patients with thoracolumbar fractures to reduce blood loss and hospital stay.

This systematic review and meta-analysis evaluated the outcomes of minimally invasive (MIS) versus open fixation for thoracolumbar (TL) fractures in patients with ankylosing spondylitis (AS). The analysis included 443 patients with a mean follow-up of 24.27 ± 15.10 months.

The meta-analysis found that MIS fixation significantly reduced operative time (150.97 ± 50.96 min vs. 251.43 ± 84.36 min, P<0.001), blood loss (275.73 ± 100 mL vs. 856.44 ± 294.91 mL, P=0.016), and hospital stay duration (17.68 ± 10.93 d vs. 32.44 ± 13.58 d, P<0.001) compared to open fixation. Bony healing rates were not significantly different between the two groups (98% for MIS vs. 97.14% for open fixation, P=0.978).

Regarding revision surgery, no statistically significant difference was found between MIS (1.39%) and open fixation (8%, P=0.135). The authors suggest that MIS is a viable approach for TL fractures in patients with AS, providing comparable bony healing while improving several perioperative metrics. Clinical application should consider these findings as evidence of the feasibility of MIS techniques in this specific population.

How this fits prior evidence

This meta-analysis addresses a gap in surgical management for complications in ankylosing spondylitis (AS). While previous coverage identified risk factors such as Crohn disease and ulcerative colitis, and genetic markers like HLA-B27, this study focuses on the surgical intervention of thoracolumbar fractures. It confirms that MIS is a viable technique for these patients, offering comparable bony healing to open fixation while improving operative metrics.

A review of data from 443 patients helped compare two ways to treat thoracolumbar fractures in people with ankylosing spondylitis. Researchers looked at minimally invasive (MIS) fixation versus traditional open fixation methods. The goal was to see which method worked better for healing and patient recovery.

The results showed that both surgical methods were effective at helping bones heal, with no significant difference found between the two techniques. However, the minimally invasive approach was associated with significantly shorter operation times, less blood loss during surgery, and shorter hospital stays compared to open fixation.

While the study suggests that minimally invasive surgery is a viable option for these patients, it is important to note that results regarding revision surgeries were not statistically significant. Patients should discuss these specific surgical options and their personal health needs with their medical team to determine the best path forward.

What this means for you:

Minimally invasive surgery may reduce blood loss and recovery time for certain spinal fractures in AS patients.

Common questions

Is minimally invasive surgery safe for spinal fractures in people with ankylosing spondylitis?

The study suggests that minimally invasive fixation is a viable option. It showed similar rates of bony healing compared to open fixation, with 98% success for MIS and 97.14% for open fixation. Because the results are based on a meta-analysis, you should talk to your doctor about which method is safest for your specific condition.

Does one method result in fewer follow-up surgeries?

The study looked at revision surgery rates and found 1.39% for minimally invasive fixation and 8% for open fixation. However, this specific difference was not statistically significant. You should discuss the long-term risks of both procedures with your surgeon.

Study Details

Study typeMeta analysis

Sample sizen = 443

EvidenceLevel 1

PublishedAug 2026

PMID42497406

View Original Abstract ↓

STUDY DESIGN: Systematic Review and Meta-Analysis. OBJECTIVE: This review aims to evaluate medical complications, patient-reported outcomes, and bony healing, operative time, and blood loss after MIS versus open fixation for TL fractures in patients with AS. SUMMARY OF BACKGROUND DATA: Ankylosing spondylitis (AS) causes spinal rigidity and increases the risk of vertebral fractures, especially in the thoracolumbar (TL) region. While pedicle screw fixation via percutaneous or open approaches is commonly used, evidence on the safety and bony healing outcomes specifically in AS patients is limited. This study evaluates medical complications, patient-reported outcomes, and bony healing after minimally invasive (MIS) versus open fixation in AS patients with TL fractures. METHODS: This systematic review and meta-analysis evaluated postoperative complications and clinical outcomes in patients with AS undergoing MIS or open fixation of TL fractures by querying PubMed, SCOPUS, CINAHL, and Web of Science, up to August 26, 2024. RESULTS: Nine comparative and 4 noncomparative studies (n=443; 77.16% male; mean age 70.74 ± 9.21 y; mean follow-up 24.27 ± 15.10 mo) were included. Bony healing was achieved in 98% (n=111) and 97.14% (n=35) of MIS and open fixation patients, respectively, which was not significantly different (P=0.978). However, MIS had a significantly shorter mean operative time (150.97 ± 50.96 vs. 251.43 ± 84.36 min; P<0.001), less blood loss (275.73 ± 100 vs. 856.44 ± 294.91 mL; P=0.016) and shorter hospital stay (17.68 ± 10.93 d vs. 32.44 ± 13.58 d; P<0.001) compared with open fixation, respectively. Revision surgery was necessitated in 1.39% (n=1) of MIS patients and in 8% (n=4) of open fixation patients, which was not found to be significantly different (P=0.135). CONCLUSIONS: Percutaneous MIS instrumented fixation for TL fractures in patients with AS is viable, affording comparable bony healing, reduced blood loss, operative time, and hospital stay compared to traditional open fixation.

Minimally invasive fixation of thoracolumbar fractures in ankylosing spondylitis reduces operative time and blood lossMinimally Invasive Surgery Shows Benefits for Ankylosing Spondylitis Fractures

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Common questions

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