ArticleBMC musculoskeletal disorders2026
Fracture morphology-driven surgical strategy in ankylosing spondylitis: when does sagittal imbalance mandate pedicle subtraction osteotomy?
Article in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThoracolumbar fractures in patients with ankylosing spondylitis (AS) pose unique challenges due to altered spinal biomechanics and sagittal imbalance. Optimal surgical strategies remain controversial, and objective criteria for selecting between deformity-corrective and fusion-only procedures are lacking.
methodsWe retrospectively reviewed 41 AS patients with thoracolumbar fractures who underwent surgical treatment. Patients were categorized as vertebral body (VB) type or intervertebral space (IS) type fractures. The primary outcome was surgical strategy selection, defined as pedicle subtraction osteotomy (PSO) versus non-PSO procedures. Propensity score matching (PSM) was performed using preoperative clinical and radiographic parameters to minimize selection bias in comparing outcomes between fracture types. Radiographic outcomes, pain improvement, and complication rates were compared. Predictive modeling using logistic regression and decision tree analysis was conducted to identify determinants of surgical strategy.
resultsA total of 41 patients (24 VB-type, 17 IS-type) were included. The VB group exhibited significantly greater preoperative sagittal imbalance and underwent PSO more frequently, while IS-type fractures were treated with posterior spinal fusion (PSF). PSM analysis (n = 17 per group) confirmed greater radiographic correction in the VB group without differences in pain outcomes. The decision tree model achieved an accuracy of 82.9% and AUC = 0.88 (95% CI: 0.85–0.99), with C7SVA > 222.6 mm as the primary decision criterion. Multivariable logistic regression identified C7SVA as the only statistically significant predictor (OR = 1.013; 95% CI: 1.001–1.026; p = 0.039). These findings suggest promising but preliminary discriminative ability, and external validation is warranted.
conclusionsIn AS patients with VB-type thoracolumbar fractures, preoperative C7SVA > 222.6 mm represents a data-supported threshold for PSO, while C7SVA > 186.8 mm combined with BMD ≤ − 2.25 identifies a secondary risk group warranting PSO consideration. PSF alone appears sufficient for IS-type injuries with relatively preserved sagittal alignment. Preoperative sagittal profiling and bone mineral density assessment enable individualized, data-driven surgical planning in this high-risk population.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.