Journal of Neurosurgery: Spine. 2026;45(2):160–169
Objective
To compare minimally invasive percutaneous fixation with conventional open fixation for thoracolumbar fractures in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis.
Methods
Retrospective 15-year cohort from a tertiary level I trauma center. Ninety-eight patients were included: 73 underwent navigation-assisted percutaneous fixation and 25 underwent open fixation with arthrodesis.
Main results
Patients treated percutaneously had greater baseline comorbidity but significantly lower estimated blood loss and transfusion requirements. Operative time, hospital stay, 90-day complications and one-year reoperation rates were not significantly different between groups.
Interpretation
Navigation-assisted percutaneous fixation may reduce the physiological burden of surgery without an evident increase in complications or reoperations—an important advantage in this medically fragile population.
Limitations
Retrospective, nonrandomized study with unequal groups. Technique selection reflected surgeon preference, creating a risk of selection bias.
Clinical takeaway
When anatomy and resources permit, percutaneous long-segment fixation is a reasonable strategy for ankylosed-spine fractures, particularly in patients with substantial medical comorbidity.
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