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A Retrospective Comparative Study of Early and Mid-to Long-Term Clinical Efficacy and Spinopelvic Sagittal Alignment
Chengyue Wang1, Haifu Sun1, Tianci Fang2
1Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Objective:
This study compared radiographic spinopelvic alignment parameters and clinical outcomes after multisegment posterior lumbar interbody fusion (PLIF) with different degrees of sagittal correction in multilevel degenerative lumbar spine disease.
Methods:
We retrospectively reviewed adults who underwent three-segment PLIF (L2-L5 or L3-S1) between January 2020 and August 2021. Patients were stratified post hoc by achieved change in fused-segment lordosis (ΔSL) from preoperative to early postoperative radiographs (ΔSL ≤5° vs >5°). Spinopelvic parameters (SL, lumbar lordosis [LL], pelvic tilt [PT], sacral slope [SS], pelvic incidence [PI], PI-LL) and patient-reported outcomes (Visual Analog Scale [VAS], Oswestry Disability Index [ODI]) were assessed preoperatively and at follow-up (≥2 years).
Results:
A total of 157 patients were included (Group A, n = 85; Group B, n = 72) with comparable baseline parameters. At 1 month and 1 year, SL was higher in Group B. At final follow-up, Group B showed more favorable alignment (higher SL/LL and lower PT/PI-LL) and better VAS/ODI than Group A (all p < 0.05). Postoperative complications were similar, except for a higher ileus rate in Group B (p = 0.024).
Conclusions:
A larger achieved ΔSL was associated with improved mid-to long-term spinopelvic alignment parameters and better final follow-up patient-reported outcomes. This potential benefit may occur at the expense of worse early postoperative symptoms; prospective studies with predefined correction targets are warranted.
