Can we use shorter constructs while maintaining satisfactory sagittal plane alignment for adult spinal deformity?

Area of Science:

• Spine surgery
• Orthopedics
• Adult spinal deformity (ASD) management

Background:

• Spinopelvic fixation in ASD can lead to reduced spinal mobility, complications, and high costs.
• Factors influencing successful short fusion for ASD remain largely unknown.

Purpose of the Study:

• To evaluate radiographic and clinical outcomes of short fusion in ASD patients with lumbar kyphosis.
• To identify factors associated with successful short fusion at 2-year follow-up.

Main Methods:

• Single-center study of 37 ASD patients with lumbar kyphosis, undergoing short fusion.
• Exclusion criteria included age < 40, prior fractures, severe osteoporosis, and specific kyphosis/scoliosis parameters.
• Assessed surgical procedures, radiographic parameters, and Oswestry Disability Index (ODI).

Main Results:

• A mean of 3.5 levels were fused, with significant improvements in coronal Cobb angle, lumbar lordosis (LL), and sagittal vertical axis (SVA).
• Mean ODI improved from 50.7% to 24.1% at 2 years.
• Preoperative pelvic incidence (PI) < 47° was identified as a key factor for successful outcomes (AUC 0.75).

Conclusions:

• Short fusion in ASD with lumbar kyphosis, particularly when PI < 47°, can achieve adequate LL and improve spinal alignment.
• Preserving mobile segments through short fusion enhances postoperative quality of life.
• This technique offers a viable alternative to longer fusions for select ASD subtypes.