Combined Anterior-Posterior vs. Posterior-Only Fusion in Adult Spinal Deformity Radiographic, Clinical, and Mechanical Outcomes With Longitudinal Mixed-Effects Analysis
In brief
Combined spinal fusion had 3% rod fractures versus 15% with posterior-only surgery
In this single-center study of 207 adults having long-segment fusion, rod fractures occurred in 3.3% of patients treated with combined anterior-posterior surgery and 14.8% treated with posterior-only surgery. Combined surgery also achieved greater sustained spinal alignment correction, while patient-reported improvement was similar. The retrospective comparison cannot establish that the approach caused fewer fractures, and its adjusted analysis did not confirm a significant reduction.
- Journal
- Global spine journal (Q1)
- Published
- 20 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Nuri Demirci, Mohamed A Zaazoue, Caglar Yilgor, Yasemin Yavuz, Tugba Akkaya Hocagil, R Adams Cowley, et al.
- PMID
- 42901499
- DOI
- 10.1177/21925682261499343
Why clinicians should know about it
- Picked for Spine Surgery (paper of the day, 22 October 2026): Compares fusion approaches, alignment correction, and mechanical complications
Abstract
Study DesignRetrospective cohort study.ObjectivesTo compare radiographic, clinical, and mechanical outcomes of posterior-only versus combined anterior-posterior fusion in adult spinal deformity (ASD) patients undergoing long-segment thoracolumbar fusion with pelvic fixation.MethodsConsecutive ASD patients undergoing instrumented fusion ≥7 levels with pelvic fixation at a single center (2016-2023) were stratified by surgical approach. Longitudinal radiographic changes were analyzed using linear mixed-effects models with difference-in-differences (DiD) estimation. Mechanical complications were evaluated with Kaplan-Meier survival and Cox proportional hazards analysis.Results207 patients were included (posterior-only, n=115; combined, n=92). Mean age was 62.1 ± 11.1 years (77.8% female), with mean follow-up of 46.2 ± 21.2 months. The combined approach demonstrated significantly greater DiD estimates for lumbar lordosis (-7.8° to -9.2°, all p<0.001), relative pelvic version mismatch (+3.4° to +4.2°, all p<0.001), and GAP score (-1.8 to -2.1, all p<0.001) at all postoperative timepoints. DiD estimates were stable across three covariate specifications. Rod fractures occurred in 14.8% of posterior-only versus 3.3% of combined patients (p=0.008), with superior rod fracture-free survival in the combined cohort (log-rank p=0.019). In the primary Cox model, the combined approach showed a non-significant trend toward lower rod fracture hazard (HR 0.35, 95% CI 0.10-1.24, p=0.10). Patient-reported outcomes improved comparably in both groups.ConclusionsIn long-segment ASD fusion with pelvic fixation, the combined anterior-posterior approach was associated with greater sustained sagittal correction and lower rod fracture rates, while both approaches provided comparable clinical improvement.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.