Advances in application of digital technologies in surgery for ankylosing spondylitis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Haorui ¹ , LIU Lu ² ,  KANG Nan ²

1. Third Clinical Medical College, Capital Medical University, Beijing, 100020, P. R. China;
2. Department of Orthopedics, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100020, P. R. China;

Corresponding author：

KANG Nan, Email: kangnan166@163.com

Keywords：

Ankylosing spondylitis; digital technology; robot-assisted surgery; three-dimensional printing; hip arthroplasty

DOI：

10.7507/1002-1892.202504017

Video：

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Objective To explore the application progress and clinical value of digital technologies in the surgical treatment of ankylosing spondylitis (AS). Methods By systematically reviewing domestic and international literature, the study summarized the specific application scenarios, operational procedures, and technical advantages of digital technologies (including preoperative three-dimensional (3D) planning, intraoperative real-time navigation, robot-assisted surgery, and 3D printing) in AS surgery, and analyzed their impact on surgical accuracy, complication rates, and clinical outcomes. Results Digital technologies significantly improve the precision and safety of AS surgery. Preoperative 3D planning enables personalized surgical protocols; intraoperative navigation systems dynamically adjusts surgical trajectories, reducing the risk of iatrogenic injury; robot-assisted surgery can minimize human errors and enhanced implant positioning accuracy; 3D-printed anatomical models and guides optimize the correction of complex spinal deformities. Furthermore, the combined applications of these technologies shorten operative time, reduce intraoperative blood loss, decrease postoperative complications (e.g., infection, nerve injury), and accelerate functional recovery.Conclusion Through multidimensional integration and innovation, digital technologies provide a precise and minimally invasive solution for AS surgical treatment. Future research should focus on their synergy with biomaterials and intelligent algorithms to further refine surgical strategies and improve long-term prognosis.

1.	Mauro D, Thomas R, Guggino G, et al. Ankylosing spondylitis: an autoimmune or autoinflammatory disease? Nat Rev Rheumatol, 2021, 17(7): 387-404.
2.	Dean LE, Jones GT, MacDonald AG, et al. Global prevalence of ankylosing spondylitis. Rheumatology (Oxford), 2014, 53(4): 650-657.
3.	Ye ZY, Bai JY, Ye ZM, et al. Surgical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with ankylosing spondylitis. BMC Musculoskelet Disord, 2024, 25(1): 484. doi: 10.1186/s12891-024-07597-6.
4.	沙西卡·那孜尔汗, 孙治国, 张树文, 等. 3D打印辅助截骨器械矫正强直性脊柱炎后凸畸形. 中国矫形外科杂志, 2023, 31(7): 613-618.
5.	Lukasiewicz AM, Bohl DD, Varthi AG, et al. Spinal fracture in patients with ankylosing spondylitis: cohort definition, distribution of injuries, and hospital outcomes. Spine (Phila Pa 1976), 2016, 41(3): 191-196.
6.	宋若先, 张永刚. 强直性脊柱炎后凸畸形矫形修复中截骨方法的进展. 中国组织工程研究, 2012, 16(17): 3218-3222.
7.	Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S171-S178.
8.	张博. 数字化技术辅助精准截骨在治疗强直性脊柱炎胸腰椎后凸畸形中的应用研究. 开封: 河南大学, 2023.
9.	张博, 杨光, 吕东波, 等. 术前应用Surgimap Spine辅助设计截骨矫形治疗强直性脊柱炎胸腰椎后凸畸形的临床疗效. 中国脊柱脊髓杂志, 2022, 32(4): 297-304.
10.	马宁. 数字化技术辅助精准截骨治疗强直性脊柱炎后凸畸形的应用研究. 郑州: 郑州大学, 2019.
11.	Zhu L, Zhang C, Peng L, et al. A case report on digital preoperative design, clinical application and finite element analysis for a patient with ankylosing spondylitis kyphosis. Front Bioeng Biotechnol, 2023, 11: 1220102. doi: 10.3389/fbioe.2023.1220102.
12.	王华锋, 毕成, 陈仲强. 强直性脊柱炎合并Andersson损害的研究进展. 中华外科杂志, 2017, 55(10): 798-800.
13.	Peng YJ, Zhou Z, Wang QL, et al. Ankylosing spondylitis complicated with andersson lesion in the lower cervical spine: A case report. World J Clin Cases, 2022, 10(11): 3533-3540.
14.	张伟, 于海洋, 翟云雷, 等. 经病损间隙楔形截骨矫治强直性脊柱炎重度脊柱后凸畸形伴Andersson损害. 颈腰痛杂志, 2024, 45(5): 964-967.
15.	丁柯元. 强直性脊柱炎胸腰段Andersson病损一期后路360° 融合固定的疗效分析. 西安: 西安医学院, 2020.
16.	彭元昊, 成凯, 朱浩天, 等. 个性化3D打印导板辅助重度脊柱后凸畸形手术矫正. 陆军军医大学学报, 2024, 46(21): 2443-2450.
17.	Ding H, Hai Y, Zhou L, et al. Clinical application of personalized digital surgical planning and precise execution for severe and complex adult spinal deformity correction utilizing 3D printing techniques. J Pers Med, 2023, 13(4): 602. doi: 10.3390/jpm13040602.
18.	Yuan X, Tao R, Zhu M, et al. Case report: Endoscopic lumbar interbody fusion using percutaneous unilateral biportal endoscopy and 3D printing for an andersson lesion in ankylosing spondylitis. Front Surg, 2025, 12: 1428072. doi: 10.3389/fsurg.2025.1428072.
19.	Yson SC, Sembrano JN, Sanders PC, et al. Comparison of cranial facet joint violation rates between open and percutaneous pedicle screw placement using intraoperative 3-D CT (O-arm) computer navigation. Spine (Phila Pa 1976), 2013, 38(4): E251-E258.
20.	Restelli U, Anania CD, Porazzi E, et al. An observational analysis of costs and effectiveness of an intraoperative compared with a preoperative image-guided system in spine surgery fixation: analysis of 10 years of experience. J Neurosurg Sci, 2022, 66(4): 350-355.
21.	Kim TT, Johnson JP, Pashman R, et al. Minimally invasive spinal surgery with intraoperative image-guided navigation. Biomed Res Int, 2016, 2016: 5716235. doi: 10.1155/2016/5716235.
22.	俞仲翔, 王树强, 史萌, 等. O型臂导航在强直性脊柱炎合并下颈椎骨折治疗中的应用. 局解手术学杂志, 2019, 28(10): 798-802.
23.	Li B, Guo R, Jiang X, et al. Posterior wedge osteotomy assisted by O-arm navigation for treating ankylosing spondylitis with thoracolumbar fractures: an early clinical evaluation. Ann Palliat Med, 2021, 10(6): 6694-6705.
24.	Li CM, Zhao SJ, Xu JZ, et al. Case series: O-arm navigation assisted by the Wiltse approach improves the accuracy of pedicle screw placement in ankylosing spondylitis combined with thoracolumbar fractures. Medicine (Baltimore), 2023, 102(52): e36807. doi: 10.1097/MD.0000000000036807.
25.	Otomo N, Funao H, Yamanouchi K, et al. Computed tomography-based navigation system in current spine surgery: a narrative review. Medicina (Kaunas), 2022, 58(2): 241. doi: 10.3390/medicina58020241.
26.	Gao C, Phalen H, Sefati S, et al. Fluoroscopic navigation for a surgical robotic system including a continuum manipulator. IEEE Trans Biomed Eng, 2022, 69(1): 453-464.
27.	龚光耀. 天玑骨科机器人辅助椎弓根螺钉内固定术的临床应用. 基层医学论坛, 2024, 28(32): 33-36.
28.	袁伟, 刘欣春, 丛琳, 等. 机器人与传统透视辅助内固定手术治疗强直性脊柱炎胸腰椎骨折的回顾性研究. 中国修复重建外科杂志, 2024, 38(8): 929-934.
29.	王宾, 王晓龙, 刘倩, 等. 3D打印导板辅助置钉在强直性脊柱炎合并胸腰椎骨折治疗中的应用. 临床骨科杂志, 2024, 27(6): 769-772.
30.	杜瑞, 张雨, 秦江辉, 等. 强直性脊柱炎机器人辅助直前入路同期双侧全髋置换1例报告. 中国矫形外科杂志, 2025, 33(2): 190-192.
31.	傅凯, 郑立铭, 蒋青, 等. 机器人辅助下“比基尼”切口直接前入路人工全髋关节置换术治疗强直性脊柱炎骨性融合髋一例. 中国修复重建外科杂志, 2022, 36(4): 523-524.
32.	傅凯, 朱博闻, 蒋青, 等. MAKO机器臂辅助直接前入路人工全髋关节置换术治疗骨性融合髋. 中国修复重建外科杂志, 2022, 36(11): 1357-1362.
33.	卢雯, 翁晓蓓, 朱金明. 1例强直性脊柱炎患者行MAKO机器人辅助全髋关节置换术的围手术期护理. 医药高职教育与现代护理, 2024, 7(5): 434-437.
34.	王远, 裴方, 万丰, 等. 人工全髋关节置换术中采用联合前倾角技术治疗强直性脊柱炎累及髋关节的疗效观察. 中国修复重建外科杂志, 2024, 38(1): 15-21.
35.	Chai W, Guo RW, Puah KL, et al. Use of robotic-arm assisted technique in complex primary total hip arthroplasty. Orthop Surg, 2020, 12(2): 686-691.
36.	Singh A, Telagareddy K, Kumar P, et al. Robotic total hip arthroplasty for fused hips in ankylosing spondylitis patients: Our experience with robotic arm technology. SICOT J, 2022, 8: 30. doi: 10.1051/sicotj/2022024.
37.	吾湖孜·吾拉木, 张晓岗, 努尔艾力江·玉山, 等. Mako 机器人辅助后外侧入路人工全髋关节置换术近期疗效. 中国修复重建外科杂志, 2021, 35(10): 1227-1232.
38.	黄家谷, 王少杰, 庄培峰, 等. 参考功能性骨盆平面安放髋臼杯假体在全髋关节置换术治疗男性强直性脊柱炎伴髋强直中预防脱位的应用. 中国老年学杂志, 2021, 41(23): 5213-5216.
39.	梁一鸣. 强直性脊柱炎髋关节强直行全髋关节置换术的疗效分析及有限元分析. 昆明: 昆明医科大学, 2023.
40.	Liu Y, Wang F, Ying J, et al. Biomechanical analysis and clinical observation of 3D-printed acetabular prosthesis for the acetabular reconstruction of total hip arthroplasty in Crowe Ⅲ hip dysplasia. Front Bioeng Biotechnol, 2023, 11: 1219745. doi: 10.3389/fbioe.2023.1219745.
41.	龙旭东, 方家栋, 杨黎, 等. 数字化技术在骨科手术中的应用进展. 海南医学, 2022, 33(13): 1737-1740.
42.	Li B, Zhang M, Lu Q, et al. Application and development of modern 3D printing technology in the field of orthopedics. Biomed Res Int, 2022, 2022: 8759060. doi: 10.1155/2022/8759060.
43.	Li Z. Digital orthopedics: The future developments of orthopedic surgery. J Pers Med, 2023, 13(2): 292. doi: 10.3390/jpm13020292.
44.	Chapman JR, Wang JC, Wiechert K. We need RI and not just AI! Thoughts on the implementation of artificial intelligence in medicine and spine surgery specifically. Global Spine J, 2024, 14(8): 2213-2215.
45.	Ghaednia H, Fourman MS, Lans A, et al. Augmented and virtual reality in spine surgery, current applications and future potentials. Spine J, 2021, 21(10): 1617-1625.
46.	Baker M, Lontchi R, Buser Z. Are AI and VR tools changing spine education and training? Artificial Intelligence Surgery, 2025, 5(1): 73-81.

1. Mauro D, Thomas R, Guggino G, et al. Ankylosing spondylitis: an autoimmune or autoinflammatory disease? Nat Rev Rheumatol, 2021, 17(7): 387-404.
2. Dean LE, Jones GT, MacDonald AG, et al. Global prevalence of ankylosing spondylitis. Rheumatology (Oxford), 2014, 53(4): 650-657.
3. Ye ZY, Bai JY, Ye ZM, et al. Surgical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with ankylosing spondylitis. BMC Musculoskelet Disord, 2024, 25(1): 484. doi: 10.1186/s12891-024-07597-6.
4. 沙西卡·那孜尔汗, 孙治国, 张树文, 等. 3D打印辅助截骨器械矫正强直性脊柱炎后凸畸形. 中国矫形外科杂志, 2023, 31(7): 613-618.
5. Lukasiewicz AM, Bohl DD, Varthi AG, et al. Spinal fracture in patients with ankylosing spondylitis: cohort definition, distribution of injuries, and hospital outcomes. Spine (Phila Pa 1976), 2016, 41(3): 191-196.
6. 宋若先, 张永刚. 强直性脊柱炎后凸畸形矫形修复中截骨方法的进展. 中国组织工程研究, 2012, 16(17): 3218-3222.
7. Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S171-S178.
8. 张博. 数字化技术辅助精准截骨在治疗强直性脊柱炎胸腰椎后凸畸形中的应用研究. 开封: 河南大学, 2023.
9. 张博, 杨光, 吕东波, 等. 术前应用Surgimap Spine辅助设计截骨矫形治疗强直性脊柱炎胸腰椎后凸畸形的临床疗效. 中国脊柱脊髓杂志, 2022, 32(4): 297-304.
10. 马宁. 数字化技术辅助精准截骨治疗强直性脊柱炎后凸畸形的应用研究. 郑州: 郑州大学, 2019.
11. Zhu L, Zhang C, Peng L, et al. A case report on digital preoperative design, clinical application and finite element analysis for a patient with ankylosing spondylitis kyphosis. Front Bioeng Biotechnol, 2023, 11: 1220102. doi: 10.3389/fbioe.2023.1220102.
12. 王华锋, 毕成, 陈仲强. 强直性脊柱炎合并Andersson损害的研究进展. 中华外科杂志, 2017, 55(10): 798-800.
13. Peng YJ, Zhou Z, Wang QL, et al. Ankylosing spondylitis complicated with andersson lesion in the lower cervical spine: A case report. World J Clin Cases, 2022, 10(11): 3533-3540.
14. 张伟, 于海洋, 翟云雷, 等. 经病损间隙楔形截骨矫治强直性脊柱炎重度脊柱后凸畸形伴Andersson损害. 颈腰痛杂志, 2024, 45(5): 964-967.
15. 丁柯元. 强直性脊柱炎胸腰段Andersson病损一期后路360° 融合固定的疗效分析. 西安: 西安医学院, 2020.
16. 彭元昊, 成凯, 朱浩天, 等. 个性化3D打印导板辅助重度脊柱后凸畸形手术矫正. 陆军军医大学学报, 2024, 46(21): 2443-2450.
17. Ding H, Hai Y, Zhou L, et al. Clinical application of personalized digital surgical planning and precise execution for severe and complex adult spinal deformity correction utilizing 3D printing techniques. J Pers Med, 2023, 13(4): 602. doi: 10.3390/jpm13040602.
18. Yuan X, Tao R, Zhu M, et al. Case report: Endoscopic lumbar interbody fusion using percutaneous unilateral biportal endoscopy and 3D printing for an andersson lesion in ankylosing spondylitis. Front Surg, 2025, 12: 1428072. doi: 10.3389/fsurg.2025.1428072.
19. Yson SC, Sembrano JN, Sanders PC, et al. Comparison of cranial facet joint violation rates between open and percutaneous pedicle screw placement using intraoperative 3-D CT (O-arm) computer navigation. Spine (Phila Pa 1976), 2013, 38(4): E251-E258.
20. Restelli U, Anania CD, Porazzi E, et al. An observational analysis of costs and effectiveness of an intraoperative compared with a preoperative image-guided system in spine surgery fixation: analysis of 10 years of experience. J Neurosurg Sci, 2022, 66(4): 350-355.
21. Kim TT, Johnson JP, Pashman R, et al. Minimally invasive spinal surgery with intraoperative image-guided navigation. Biomed Res Int, 2016, 2016: 5716235. doi: 10.1155/2016/5716235.
22. 俞仲翔, 王树强, 史萌, 等. O型臂导航在强直性脊柱炎合并下颈椎骨折治疗中的应用. 局解手术学杂志, 2019, 28(10): 798-802.
23. Li B, Guo R, Jiang X, et al. Posterior wedge osteotomy assisted by O-arm navigation for treating ankylosing spondylitis with thoracolumbar fractures: an early clinical evaluation. Ann Palliat Med, 2021, 10(6): 6694-6705.
24. Li CM, Zhao SJ, Xu JZ, et al. Case series: O-arm navigation assisted by the Wiltse approach improves the accuracy of pedicle screw placement in ankylosing spondylitis combined with thoracolumbar fractures. Medicine (Baltimore), 2023, 102(52): e36807. doi: 10.1097/MD.0000000000036807.
25. Otomo N, Funao H, Yamanouchi K, et al. Computed tomography-based navigation system in current spine surgery: a narrative review. Medicina (Kaunas), 2022, 58(2): 241. doi: 10.3390/medicina58020241.
26. Gao C, Phalen H, Sefati S, et al. Fluoroscopic navigation for a surgical robotic system including a continuum manipulator. IEEE Trans Biomed Eng, 2022, 69(1): 453-464.
27. 龚光耀. 天玑骨科机器人辅助椎弓根螺钉内固定术的临床应用. 基层医学论坛, 2024, 28(32): 33-36.
28. 袁伟, 刘欣春, 丛琳, 等. 机器人与传统透视辅助内固定手术治疗强直性脊柱炎胸腰椎骨折的回顾性研究. 中国修复重建外科杂志, 2024, 38(8): 929-934.
29. 王宾, 王晓龙, 刘倩, 等. 3D打印导板辅助置钉在强直性脊柱炎合并胸腰椎骨折治疗中的应用. 临床骨科杂志, 2024, 27(6): 769-772.
30. 杜瑞, 张雨, 秦江辉, 等. 强直性脊柱炎机器人辅助直前入路同期双侧全髋置换1例报告. 中国矫形外科杂志, 2025, 33(2): 190-192.
31. 傅凯, 郑立铭, 蒋青, 等. 机器人辅助下“比基尼”切口直接前入路人工全髋关节置换术治疗强直性脊柱炎骨性融合髋一例. 中国修复重建外科杂志, 2022, 36(4): 523-524.
32. 傅凯, 朱博闻, 蒋青, 等. MAKO机器臂辅助直接前入路人工全髋关节置换术治疗骨性融合髋. 中国修复重建外科杂志, 2022, 36(11): 1357-1362.
33. 卢雯, 翁晓蓓, 朱金明. 1例强直性脊柱炎患者行MAKO机器人辅助全髋关节置换术的围手术期护理. 医药高职教育与现代护理, 2024, 7(5): 434-437.
34. 王远, 裴方, 万丰, 等. 人工全髋关节置换术中采用联合前倾角技术治疗强直性脊柱炎累及髋关节的疗效观察. 中国修复重建外科杂志, 2024, 38(1): 15-21.
35. Chai W, Guo RW, Puah KL, et al. Use of robotic-arm assisted technique in complex primary total hip arthroplasty. Orthop Surg, 2020, 12(2): 686-691.
36. Singh A, Telagareddy K, Kumar P, et al. Robotic total hip arthroplasty for fused hips in ankylosing spondylitis patients: Our experience with robotic arm technology. SICOT J, 2022, 8: 30. doi: 10.1051/sicotj/2022024.
37. 吾湖孜·吾拉木, 张晓岗, 努尔艾力江·玉山, 等. Mako 机器人辅助后外侧入路人工全髋关节置换术近期疗效. 中国修复重建外科杂志, 2021, 35(10): 1227-1232.
38. 黄家谷, 王少杰, 庄培峰, 等. 参考功能性骨盆平面安放髋臼杯假体在全髋关节置换术治疗男性强直性脊柱炎伴髋强直中预防脱位的应用. 中国老年学杂志, 2021, 41(23): 5213-5216.
39. 梁一鸣. 强直性脊柱炎髋关节强直行全髋关节置换术的疗效分析及有限元分析. 昆明: 昆明医科大学, 2023.
40. Liu Y, Wang F, Ying J, et al. Biomechanical analysis and clinical observation of 3D-printed acetabular prosthesis for the acetabular reconstruction of total hip arthroplasty in Crowe Ⅲ hip dysplasia. Front Bioeng Biotechnol, 2023, 11: 1219745. doi: 10.3389/fbioe.2023.1219745.
41. 龙旭东, 方家栋, 杨黎, 等. 数字化技术在骨科手术中的应用进展. 海南医学, 2022, 33(13): 1737-1740.
42. Li B, Zhang M, Lu Q, et al. Application and development of modern 3D printing technology in the field of orthopedics. Biomed Res Int, 2022, 2022: 8759060. doi: 10.1155/2022/8759060.
43. Li Z. Digital orthopedics: The future developments of orthopedic surgery. J Pers Med, 2023, 13(2): 292. doi: 10.3390/jpm13020292.
44. Chapman JR, Wang JC, Wiechert K. We need RI and not just AI! Thoughts on the implementation of artificial intelligence in medicine and spine surgery specifically. Global Spine J, 2024, 14(8): 2213-2215.
45. Ghaednia H, Fourman MS, Lans A, et al. Augmented and virtual reality in spine surgery, current applications and future potentials. Spine J, 2021, 21(10): 1617-1625.
46. Baker M, Lontchi R, Buser Z. Are AI and VR tools changing spine education and training? Artificial Intelligence Surgery, 2025, 5(1): 73-81.

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