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 enhance 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.

Citation： YANG Haorui, LIU Lu, KANG Nan. Advances in application of digital technologies in surgery for ankylosing spondylitis. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(7): 896-902. doi: 10.7507/1002-1892.202504017 Copy

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·那孜爾汗, 孫治國, 張樹文, 等. 3D打印輔助截骨器械矯正強直性脊柱炎后凸畸形. 中國矯形外科雜志, 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, 張永剛. 強直性脊柱炎后凸畸形矯形修復中截骨方法的進展. 中國組織工程研究, 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.	張博. 數字化技術輔助精準截骨在治療強直性脊柱炎胸腰椎后凸畸形中的應用研究. 開封: 河南大學, 2023.
9.	張博, 楊光, 呂東波, 等. 術前應用Surgimap Spine輔助設計截骨矯形治療強直性脊柱炎胸腰椎后凸畸形的臨床療效. 中國脊柱脊髓雜志, 2022, 32(4): 297-304.
10.	馬寧. 數字化技術輔助精準截骨治療強直性脊柱炎后凸畸形的應用研究. 鄭州: 鄭州大學, 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.	王博寧, 楊程顯, 王漢吉, 等. 強直性脊柱炎合并Andersson損害的研究進展. 中華骨與關節外科雜志, 2024, 17(10): 944-949.
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.	張偉, 于海洋, 翟云雷, 等. 經病損間隙楔形截骨矯治強直性脊柱炎重度脊柱后凸畸形伴Andersson損害. 頸腰痛雜志, 2024, 45(5): 964-967.
15.	丁柯元. 強直性脊柱炎胸腰段Andersson病損一期后路360° 融合固定的療效分析. 西安: 西安醫學院, 2020.
16.	彭元昊, 成凱, 朱浩天, 等. 個性化3D打印導板輔助重度脊柱后凸畸形手術矯正. 陸軍軍醫大學學報, 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, 王樹強, 史萌, 等. O型臂導航在強直性脊柱炎合并下頸椎骨折治療中的應用. 局解手術學雜志, 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.	龔光耀. 天璣骨科機器人輔助椎弓根螺釘內固定術的臨床應用. 基層醫學論壇, 2024, 28(32): 33-36.
28.	袁偉, 劉欣春, 叢琳, 等. 機器人與傳統透視輔助內固定手術治療強直性脊柱炎胸腰椎骨折的回顧性研究. 中國修復重建外科雜志, 2024, 38(8): 929-934.
29.	王賓, 王曉龍, 劉倩, 等. 3D打印導板輔助置釘在強直性脊柱炎合并胸腰椎骨折治療中的應用. 臨床骨科雜志, 2024, 27(6): 769-772.
30.	杜瑞, 張雨, 秦江輝, 等. 強直性脊柱炎機器人輔助直前入路同期雙側全髖置換1例報告. 中國矯形外科雜志, 2025, 33(2): 190-192.
31.	傅凱, 鄭立銘, 蔣青, 等. 機器人輔助下“比基尼”切口直接前入路人工全髖關節置換術治療強直性脊柱炎骨性融合髖一例. 中國修復重建外科雜志, 2022, 36(4): 523-524.
32.	傅凱, 朱博聞, 蔣青, 等. MAKO機器臂輔助直接前入路人工全髖關節置換術治療骨性融合髖. 中國修復重建外科雜志, 2022, 36(11): 1357-1362.
33.	盧雯, 翁曉蓓, 朱金明. 1例強直性脊柱炎患者行MAKO機器人輔助全髖關節置換術的圍手術期護理. 醫藥高職教育與現代護理, 2024, 7(5): 434-437.
34.	王遠, 裴方, 萬豐, 等. 人工全髖關節置換術中采用聯合前傾角技術治療強直性脊柱炎累及髖關節的療效觀察. 中國修復重建外科雜志, 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, 張曉崗, 努爾艾力江·玉山, 等. Mako 機器人輔助后外側入路人工全髖關節置換術近期療效. 中國修復重建外科雜志, 2021, 35(10): 1227-1232.
38.	黃家谷, 王少杰, 莊培峰, 等. 參考功能性骨盆平面安放髖臼杯假體在全髖關節置換術治療男性強直性脊柱炎伴髖強直中預防脫位的應用. 中國老年學雜志, 2021, 41(23): 5213-5216.
39.	梁一鳴. 強直性脊柱炎髖關節強直行全髖關節置換術的療效分析及有限元分析. 昆明: 昆明醫科大學, 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.	龍旭東, 方家棟, 楊黎, 等. 數字化技術在骨科手術中的應用進展. 海南醫學, 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·那孜爾汗, 孫治國, 張樹文, 等. 3D打印輔助截骨器械矯正強直性脊柱炎后凸畸形. 中國矯形外科雜志, 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, 張永剛. 強直性脊柱炎后凸畸形矯形修復中截骨方法的進展. 中國組織工程研究, 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. 張博. 數字化技術輔助精準截骨在治療強直性脊柱炎胸腰椎后凸畸形中的應用研究. 開封: 河南大學, 2023.
9. 張博, 楊光, 呂東波, 等. 術前應用Surgimap Spine輔助設計截骨矯形治療強直性脊柱炎胸腰椎后凸畸形的臨床療效. 中國脊柱脊髓雜志, 2022, 32(4): 297-304.
10. 馬寧. 數字化技術輔助精準截骨治療強直性脊柱炎后凸畸形的應用研究. 鄭州: 鄭州大學, 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. 王博寧, 楊程顯, 王漢吉, 等. 強直性脊柱炎合并Andersson損害的研究進展. 中華骨與關節外科雜志, 2024, 17(10): 944-949.
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. 張偉, 于海洋, 翟云雷, 等. 經病損間隙楔形截骨矯治強直性脊柱炎重度脊柱后凸畸形伴Andersson損害. 頸腰痛雜志, 2024, 45(5): 964-967.
15. 丁柯元. 強直性脊柱炎胸腰段Andersson病損一期后路360° 融合固定的療效分析. 西安: 西安醫學院, 2020.
16. 彭元昊, 成凱, 朱浩天, 等. 個性化3D打印導板輔助重度脊柱后凸畸形手術矯正. 陸軍軍醫大學學報, 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, 王樹強, 史萌, 等. O型臂導航在強直性脊柱炎合并下頸椎骨折治療中的應用. 局解手術學雜志, 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. 龔光耀. 天璣骨科機器人輔助椎弓根螺釘內固定術的臨床應用. 基層醫學論壇, 2024, 28(32): 33-36.
28. 袁偉, 劉欣春, 叢琳, 等. 機器人與傳統透視輔助內固定手術治療強直性脊柱炎胸腰椎骨折的回顧性研究. 中國修復重建外科雜志, 2024, 38(8): 929-934.
29. 王賓, 王曉龍, 劉倩, 等. 3D打印導板輔助置釘在強直性脊柱炎合并胸腰椎骨折治療中的應用. 臨床骨科雜志, 2024, 27(6): 769-772.
30. 杜瑞, 張雨, 秦江輝, 等. 強直性脊柱炎機器人輔助直前入路同期雙側全髖置換1例報告. 中國矯形外科雜志, 2025, 33(2): 190-192.
31. 傅凱, 鄭立銘, 蔣青, 等. 機器人輔助下“比基尼”切口直接前入路人工全髖關節置換術治療強直性脊柱炎骨性融合髖一例. 中國修復重建外科雜志, 2022, 36(4): 523-524.
32. 傅凱, 朱博聞, 蔣青, 等. MAKO機器臂輔助直接前入路人工全髖關節置換術治療骨性融合髖. 中國修復重建外科雜志, 2022, 36(11): 1357-1362.
33. 盧雯, 翁曉蓓, 朱金明. 1例強直性脊柱炎患者行MAKO機器人輔助全髖關節置換術的圍手術期護理. 醫藥高職教育與現代護理, 2024, 7(5): 434-437.
34. 王遠, 裴方, 萬豐, 等. 人工全髖關節置換術中采用聯合前傾角技術治療強直性脊柱炎累及髖關節的療效觀察. 中國修復重建外科雜志, 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, 張曉崗, 努爾艾力江·玉山, 等. Mako 機器人輔助后外側入路人工全髖關節置換術近期療效. 中國修復重建外科雜志, 2021, 35(10): 1227-1232.
38. 黃家谷, 王少杰, 莊培峰, 等. 參考功能性骨盆平面安放髖臼杯假體在全髖關節置換術治療男性強直性脊柱炎伴髖強直中預防脫位的應用. 中國老年學雜志, 2021, 41(23): 5213-5216.
39. 梁一鳴. 強直性脊柱炎髖關節強直行全髖關節置換術的療效分析及有限元分析. 昆明: 昆明醫科大學, 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. 龍旭東, 方家棟, 楊黎, 等. 數字化技術在骨科手術中的應用進展. 海南醫學, 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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Chinese Journal of Reparative and Reconstructive Surgery

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