{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:25:33Z","timestamp":1786980333225,"version":"build-2736575974"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,11,19]],"date-time":"2022-11-19T00:00:00Z","timestamp":1668816000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,19]],"date-time":"2022-11-19T00:00:00Z","timestamp":1668816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100017291","name":"Zhongshan Science and Technology Bureau","doi-asserted-by":"publisher","award":["210329183949251"],"award-info":[{"award-number":["210329183949251"]}],"id":[{"id":"10.13039\/501100017291","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Cervical fractures with ankylosing spondylitis (CAS) are a specific type of spinal fracture with poor stability, low healing rate, and high disability rate. Its treatment is mainly surgical, predominantly through the anterior approach, posterior approach, and the anterior\u2013posterior approach. Although many clinical studies have been conducted on various surgical approaches, controversy still exists concerning the choice of these surgical approaches by surgeons. The authors present here a systematic evaluation and meta-analysis exploring the utility of the anterior\u2013posterior approach versus the anterior approach and the posterior approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>After a comprehensive literature search of PubMed, Cochrane, Web of Science, and Embase databases, 12 clinical studies were included in the final qualitative analysis and 8 in the final quantitative analysis. Of these studies, 11 conducted a comparison between the anterior\u2013posterior approach and the anterior approach and posterior approaches, while one examined only the anterior\u2013posterior approach. Where appropriate, statistical advantage ratios and 95% confidence intervals were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The present meta-analysis of postoperative neurological improvement showed no statistical difference in the overall neurological improvement rate between the anterior\u2013posterior approach and anterior approach (OR 1.70, 95% CI 0.61 to 4.75;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.31). However, the mean change in postoperative neurological function was lower in patients who received the anterior approach than in those who received the anterior\u2013posterior approach (MD 0.17, 95% CI -0.02 to 0.36;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.08). There was an identical trend between the anterior\u2013posterior approach and posterior approach, with no statistically significant difference in the overall rate of neurological improvement (OR 1.37, 95% CI 0.70 to 2.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.38). Nevertheless, the mean change in neurological function was smaller in patients receiving the anterior\u2013posterior approach compared with the posterior approach, but there was no statistically significant difference between the two (MD 0.17, 95% CI -0.02 to 0.36;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.08).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this review and meta-analysis suggest that the benefits of the anterior\u2013posterior approach are different from those of the anterior and posterior approaches in the treatment of ankylosing spondylitis-related cervical fractures. In a word, there is no significant difference between the cervical surgical approach and the neurological functional improvement. Therefore, surgeons should pay more attention to the type of cervical fracture, the displacement degree of cervical fracture, the spinal cord injury, the balance of cervical spine and other aspects to comprehensively consider the selection of appropriate surgical methods.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-022-07435-0","type":"journal-article","created":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T22:03:01Z","timestamp":1668808981000},"page":"27-37","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Combined anterior and posterior approach in treatment of ankylosing spondylitis-associated cervical fractures: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"32","author":[{"given":"Hua-Jian","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"De-Yuan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-zhen","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-li","family":"Sang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-zhe","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6905-710X","authenticated-orcid":false,"given":"Fu-li","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,11,19]]},"reference":[{"key":"7435_CR1","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s41927-019-0086-3","volume":"3","author":"J Walsh","year":"2019","unstructured":"Walsh J, Hunter T, Schroeder K, Sandoval D, Bolce R (2019) Trends in diagnostic prevalence and treatment patterns of male and female ankylosing spondylitis patients in the United States, 2006\u20132016. BMC Rheumatol 3:39. https:\/\/doi.org\/10.1186\/s41927-019-0086-3","journal-title":"BMC Rheumatol"},{"key":"7435_CR2","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1093\/bmb\/ldv010","volume":"115","author":"UG Longo","year":"2015","unstructured":"Longo UG, Loppini M, Petrillo S, Berton A, Maffulli N, Denaro V (2015) Management of cervical fractures in ankylosing spondylitis: anterior, posterior or combined approach? Br Med Bull 115:57\u201366. https:\/\/doi.org\/10.1093\/bmb\/ldv010","journal-title":"Br Med Bull"},{"key":"7435_CR3","doi-asserted-by":"publisher","first-page":"R17","DOI":"10.1186\/ar2368","volume":"10","author":"QY Zeng","year":"2008","unstructured":"Zeng QY, Chen R, Darmawan J, Xiao ZY, Chen SB, Wigley R, Le Chen S, Zhang NZ (2008) Rheumatic diseases in China. Arthritis Res Ther 10:R17. https:\/\/doi.org\/10.1186\/ar2368","journal-title":"Arthritis Res Ther"},{"key":"7435_CR4","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1177\/2192568217700108","volume":"7","author":"S Hartmann","year":"2017","unstructured":"Hartmann S, Tschugg A, Wipplinger C, Thome C (2017) Analysis of the literature on cervical spine fractures in ankylosing spinal disorders. Global Spine J 7:469\u2013481. https:\/\/doi.org\/10.1177\/2192568217700108","journal-title":"Global Spine J"},{"key":"7435_CR5","doi-asserted-by":"publisher","first-page":"E12","DOI":"10.3171\/FOC\/2008\/24\/1\/E12","volume":"24","author":"WB Jacobs","year":"2008","unstructured":"Jacobs WB, Fehlings MG (2008) Ankylosing spondylitis and spinal cord injury: origin, incidence, management, and avoidance. Neurosurg Focus 24:E12. https:\/\/doi.org\/10.3171\/FOC\/2008\/24\/1\/E12","journal-title":"Neurosurg Focus"},{"key":"7435_CR6","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/j.otsr.2015.02.005","volume":"101","author":"JY Lazennec","year":"2015","unstructured":"Lazennec JY, d\u2019Astorg H, Rousseau MA (2015) Cervical spine surgery in ankylosing spondylitis: Review and current concept. Orthop Traumatol Surg Res 101:507\u2013513. https:\/\/doi.org\/10.1016\/j.otsr.2015.02.005","journal-title":"Orthop Traumatol Surg Res"},{"key":"7435_CR7","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.jocn.2017.04.012","volume":"41","author":"H Chon","year":"2017","unstructured":"Chon H, Park JH (2017) Cervical vertebral body fracture with ankylosing spondylitis treated with cervical pedicle screw: a fracture body overlapping reduction technique. J Clin Neurosci 41:150\u2013153. https:\/\/doi.org\/10.1016\/j.jocn.2017.04.012","journal-title":"J Clin Neurosci"},{"key":"7435_CR8","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/s12891-017-1396-5","volume":"18","author":"L Yan","year":"2017","unstructured":"Yan L, Luo Z, He B, Liu J, Hao D (2017) Posterior pedicle screw fixation to treat lower cervical fractures associated with ankylosing spondylitis: a retrospective study of 35 cases. BMC Musculoskelet Disord 18:81. https:\/\/doi.org\/10.1186\/s12891-017-1396-5","journal-title":"BMC Musculoskelet Disord"},{"key":"7435_CR9","doi-asserted-by":"publisher","first-page":"9205834","DOI":"10.1155\/2017\/9205834","volume":"2017","author":"B Yang","year":"2017","unstructured":"Yang B, Lu T, Li H (2017) Single-session combined anterior-posterior approach for treatment of ankylosing spondylitis with obvious displaced lower cervical spine fractures and dislocations. Biomed Res Int 2017:9205834. https:\/\/doi.org\/10.1155\/2017\/9205834","journal-title":"Biomed Res Int"},{"key":"7435_CR10","doi-asserted-by":"publisher","first-page":"510","DOI":"10.5137\/1019-5149.JTN.31174-20.2","volume":"31","author":"AI Okten","year":"2021","unstructured":"Okten AI, Arslan A, Olguner SK, Acik V, Istemen I, Arslan B, Gezercan Y (2021) Surgical outcomes of subaxial cervical fractures in patients with ankylosing spinal disorder. Turk Neurosurg 31:510\u2013518. https:\/\/doi.org\/10.5137\/1019-5149.JTN.31174-20.2","journal-title":"Turk Neurosurg"},{"key":"7435_CR11","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/BF00307827","volume":"5","author":"C Olerud","year":"1996","unstructured":"Olerud C, Frost A, Bring J (1996) Spinal fractures in patients with ankylosing spondylitis. Eur Spine J 5:51\u201355","journal-title":"Eur Spine J"},{"key":"7435_CR12","doi-asserted-by":"publisher","first-page":"33","DOI":"10.3171\/spi.2006.5.1.33","volume":"5","author":"T Einsiedel","year":"2006","unstructured":"Einsiedel T, Schmelz A, Arand M, Wilke H-J, Gebhard F, Hartwig E, Kramer M, Neugebauer R, Kinzl L, Schultheiss M (2006) Injuries of the cervical spine in patients with ankylosing spondylitis: experience at two trauma centers. J Neurosurg Spine 5:33\u201345","journal-title":"J Neurosurg Spine"},{"key":"7435_CR13","doi-asserted-by":"publisher","first-page":"108","DOI":"10.3340\/jkns.2014.56.2.108","volume":"56","author":"SB An","year":"2014","unstructured":"An SB, Kim KN, Chin DK, Kim KS, Cho YE, Kuh SU (2014) Surgical outcomes after traumatic vertebral fractures in patients with ankylosing spondylitis. J Korean Neurosurg Soc 56:108\u2013113. https:\/\/doi.org\/10.3340\/jkns.2014.56.2.108","journal-title":"J Korean Neurosurg Soc"},{"key":"7435_CR14","doi-asserted-by":"publisher","first-page":"270","DOI":"10.4103\/0019-5413.65151","volume":"44","author":"SA Badve","year":"2010","unstructured":"Badve SA, Bhojraj SY, Nene AM, Varma R, Mohite S, Kalkotwar S, Gupta A (2010) Spinal instability in ankylosing spondylitis. Indian J Orthop 44:270\u2013276. https:\/\/doi.org\/10.4103\/0019-5413.65151","journal-title":"Indian J Orthop"},{"key":"7435_CR15","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1016\/j.otsr.2012.03.011","volume":"98","author":"P Kouyoumdjian","year":"2012","unstructured":"Kouyoumdjian P, Guerin P, Schaelderle C, Asencio G, Gille O (2012) Fracture of the lower cervical spine in patients with ankylosing spondylitis: retrospective study of 19 cases. Orthop Traumatol Surg Res 98:543\u2013551. https:\/\/doi.org\/10.1016\/j.otsr.2012.03.011","journal-title":"Orthop Traumatol Surg Res"},{"key":"7435_CR16","doi-asserted-by":"publisher","first-page":"E308","DOI":"10.1097\/BSD.0000000000001155","volume":"34","author":"B Liu","year":"2021","unstructured":"Liu B, Ji H, Zhang Z, Guo Y, Lv Y, Yang Z, Hou G, Zhou F, Tian Y (2021) Surgical treatment for cervical spine fracture in patients with ankylosing spondylitis: single posterior approach or combined anterior-posterior approach? Clin Spine Surg 34:E308\u2013E314. https:\/\/doi.org\/10.1097\/BSD.0000000000001155","journal-title":"Clin Spine Surg"},{"key":"7435_CR17","doi-asserted-by":"publisher","first-page":"432","DOI":"10.31616\/asj.2018.0197","volume":"13","author":"P Luksanapruksa","year":"2019","unstructured":"Luksanapruksa P, Millhouse PW, Carlson V, Ariyawatkul T, Heller J, Kepler CK (2019) Comparison of surgical outcomes of the posterior and combined approaches for repair of cervical fractures in ankylosing spondylitis. Asian Spine J 13:432\u2013440. https:\/\/doi.org\/10.31616\/asj.2018.0197","journal-title":"Asian Spine J"},{"key":"7435_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.clineuro.2016.05.015","volume":"147","author":"Q Guo","year":"2016","unstructured":"Guo Q, Cui Y, Wang L, Lu X, Ni B (2016) Single anterior approach for cervical spine fractures at C5\u2013T1 complicating ankylosing spondylitis. Clin Neurol Neurosurg 147:1\u20135. https:\/\/doi.org\/10.1016\/j.clineuro.2016.05.015","journal-title":"Clin Neurol Neurosurg"},{"key":"7435_CR19","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000007432","volume":"96","author":"A He","year":"2017","unstructured":"He A, Xie D, Cai X, Qu B, Kong Q, Xu C, Yang L, Chen X, Jia L (2017) One-stage surgical treatment of cervical spine fracture-dislocation in patients with ankylosing spondylitis via the combined anterior-posterior approach. Medicine (Baltimore) 96:e7432. https:\/\/doi.org\/10.1097\/MD.0000000000007432","journal-title":"Medicine (Baltimore)"},{"key":"7435_CR20","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1186\/1471-2474-10-96","volume":"10","author":"G Sapkas","year":"2009","unstructured":"Sapkas G, Kateros K, Papadakis SA, Galanakos S, Brilakis E, Machairas G, Katonis P (2009) Surgical outcome after spinal fractures in patients with ankylosing spondylitis. BMC Musculoskelet Disord 10:96. https:\/\/doi.org\/10.1186\/1471-2474-10-96","journal-title":"BMC Musculoskelet Disord"},{"key":"7435_CR21","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2021.106744","volume":"207","author":"H Yang","year":"2021","unstructured":"Yang H, Wang H, Zhang B, Sun Y, Wang L, Lu X (2021) Cervical spine fracture-dislocation in patients with ankylosing spondylitis and severe thoracic kyphosis: application of halo vest before and during surgical management. Clin Neurol Neurosurg 207:106744. https:\/\/doi.org\/10.1016\/j.clineuro.2021.106744","journal-title":"Clin Neurol Neurosurg"},{"key":"7435_CR22","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1038\/sj.sc.3100619","volume":"36","author":"N Tico","year":"1998","unstructured":"Tico N, Ramon S, Garcia-Ortun F, Ramirez L, Castello T, Garcia-Fernandez L, Lience E (1998) Traumatic spinal cord injury complicating ankylosing spondylitis. Spinal Cord 36:349\u2013352. https:\/\/doi.org\/10.1038\/sj.sc.3100619","journal-title":"Spinal Cord"},{"key":"7435_CR23","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.wneu.2016.08.110","volume":"96","author":"CK Lee","year":"2016","unstructured":"Lee CK, Yoon DH, Kim KN, Yi S, Shin DA, Kim B, Lee N, Ha Y (2016) Characteristics of cervical spine trauma in patients with ankylosing spondylitis and ossification of the posterior longitudinal ligament. World Neurosurg 96:202\u2013208. https:\/\/doi.org\/10.1016\/j.wneu.2016.08.110","journal-title":"World Neurosurg"},{"key":"7435_CR24","doi-asserted-by":"publisher","first-page":"210","DOI":"10.3171\/jns.1990.72.2.0210","volume":"72","author":"KN Detwiler","year":"1990","unstructured":"Detwiler KN, Loftus CM, Godersky JC, Menezes AH (1990) Management of cervical spine injuries in patients with ankylosing spondylitis. J Neurosurg 72:210\u2013215. https:\/\/doi.org\/10.3171\/jns.1990.72.2.0210","journal-title":"J Neurosurg"},{"key":"7435_CR25","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1007\/s001320170005","volume":"30","author":"P Metz-Stavenhagen","year":"2001","unstructured":"Metz-Stavenhagen P, Krebs S, Meier O (2001) Cervical fractures in ankylosing spondylitis. Orthopade 30:925\u2013931. https:\/\/doi.org\/10.1007\/s001320170005","journal-title":"Orthopade"},{"key":"7435_CR26","doi-asserted-by":"publisher","first-page":"e1203","DOI":"10.3928\/01477447-20130821-25","volume":"36","author":"M Mathews","year":"2013","unstructured":"Mathews M, Bolesta MJ (2013) Treatment of spinal fractures in ankylosing spondylitis. Orthopedics 36:e1203-1208. https:\/\/doi.org\/10.3928\/01477447-20130821-25","journal-title":"Orthopedics"},{"key":"7435_CR27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00590-003-0110-5","volume":"14","author":"E Serin","year":"2004","unstructured":"Serin E, Karakurt L, Yilmaz E, Belhan O, Varol T (2004) Effects of two-levels, four-levels, and four-levels plus offset-hook posterior fixation techniques on protecting the surgical correction of unstable thoracolumbar vertebral fractures: a clinical study. Eur J Orthop Surg Traumatol 14:1\u20136","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"7435_CR28","doi-asserted-by":"publisher","first-page":"2035","DOI":"10.1097\/00007632-200008150-00006","volume":"25","author":"DA Taggard","year":"2000","unstructured":"Taggard DA, Traynelis VC (2000) Management of cervical spinal fractures in ankylosing spondylitis with posterior fixation. Spine (Phila Pa 1976) 25:2035\u20132039. https:\/\/doi.org\/10.1097\/00007632-200008150-00006","journal-title":"Spine (Phila Pa 1976)"},{"key":"7435_CR29","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.jocn.2005.02.010","volume":"13","author":"M Payer","year":"2006","unstructured":"Payer M (2006) Surgical management of cervical fractures in ankylosing spondylitis using a combined posterior-anterior approach. J Clin Neurosci 13:73\u201377. https:\/\/doi.org\/10.1016\/j.jocn.2005.02.010","journal-title":"J Clin Neurosci"},{"key":"7435_CR30","doi-asserted-by":"publisher","first-page":"297","DOI":"10.3760\/cma.j.issn.1001-8050.2013.4.003","volume":"29","author":"ZF Ji Hong-quan","year":"2013","unstructured":"Ji Hong-quan ZF, TlAN Yun LIU, Zhong-jun, (2013) Operation choices for cervical spinal fracture in patients with ankylosing spondylitis. Chin J Trauma 29:297\u2013301. https:\/\/doi.org\/10.3760\/cma.j.issn.1001-8050.2013.4.003","journal-title":"Chin J Trauma"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-022-07435-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-022-07435-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-022-07435-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T15:38:34Z","timestamp":1674833914000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-022-07435-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,19]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["7435"],"URL":"https:\/\/doi.org\/10.1007\/s00586-022-07435-0","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,19]]},"assertion":[{"value":"19 June 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2022","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 October 2022","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 November 2022","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No potential conflict of interest relevant to this article was reported.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}