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Does Preoperative Spinal Alignment Influence Surgical Outcomes When Postoperative Alignment and Fixation Strategies
Donghua Huang1,2, Zhan Wang1,2, Michael Jian-Wen Chen1,3
1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Spine
|March 26, 2026
Summary
For adult spinal deformity surgery, achieving target postoperative alignment is more important than the extent of correction. The amount of correction did not independently impact outcomes in patients with similar final alignment and fixation strategies.
Area of Science:
- Spine surgery
- Adult spinal deformity (ASD)
- Surgical outcomes
Background:
- Current adult spinal deformity (ASD) surgery often focuses on absolute alignment values.
- The degree of spinal correction may also influence patient outcomes.
- Previous studies have been limited by methodological issues.
Purpose of the Study:
- To investigate if the extent of correction impacts outcomes in adult spinal deformity (ASD) surgery.
- Utilize a matched-pair analysis to control for confounding variables.
Main Methods:
- Retrospective study of 114 adult spinal deformity (ASD) patients undergoing spinal fusion (≥5 levels).
- Patients were matched 1:1 based on key alignment parameters and fixation.
- Outcomes (clinical, radiographic, surgical) were analyzed as within-pair differences.
Main Results:
- 57 matched pairs were analyzed, with similar postoperative alignment and fixation.
- No significant association was found between the magnitude of correction (Δpreoperative alignment) and patient outcomes (e.g., ODI, length of stay, operative time).
- Correction magnitude did not influence binary outcomes like proximal junctional kyphosis (PJK), proximal junctional failure (PJF), reoperation, or complications.
Conclusions:
- In ASD surgery, achieving target postoperative alignment is crucial, not the degree of correction.
- Focusing on achieving desired final alignment, rather than the extent of correction, optimizes surgical planning for better recovery and reduced complication risk.
