Frontiers in surgery · 2026
Comparison of short-segment vs. long-segment fixation in posterior osteotomy for kyphotic deformity: effects on postoperative alignment and complications.
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Zhao Yulong, Yuan Qian, Zhang Na, Chen Lin, Zhang Shiduo, Li Qiang
Аннотация
BACKGROUND: Posterior osteotomy is an effective treatment for severe kyphosis; however, postoperative complications, particularly early radiographic proximal junctional kyphosis (PJK), may compromise outcomes. Evidence regarding factors influencing postoperative efficacy and complication risk remains limited.
OBJECTIVE: To compare the clinical efficacy of long-segment vs. short-segment fixation in posterior osteotomy for kyphosis and identify factors affecting outcomes and complications.
METHODS: This retrospective controlled study included 150 patients undergoing posterior thoracolumbar osteotomy with fusion and internal fixation between June 2019 and June 2023. Patients were grouped by fixation length: long-segment (group L, ≥5 segments) and short-segment (group S, ≤4 segments). Propensity score matching balanced baseline characteristics, yielding 50 patients per group. Radiographic parameters (Cobb angle, sagittal vertical axis), perioperative data, and 12-month complications were recorded. Pain and function were assessed using VAS and ODI. Multivariate logistic regression identified independent risk factors for correction loss and early radiographic PJK.
RESULTS: Both groups showed significant postoperative improvement in Cobb angle and sagittal alignment (P < 0.05). Group L achieved a higher correction rate, lower Cobb angle loss, better VAS and ODI scores, and fewer early radiographic PJK and fixation-related complications (all P < 0.05). Group S had shorter operative time and less blood loss (P < 0.05), with no difference in other complications. Short-segment fixation was independent risk factors for correction loss and early radiographic PJK.
CONCLUSION: When correcting spinal kyphosis via posterior osteotomy, long-segment fixation better maintains correction and reduces complications like early radiographic PJK, while short-segment fixation shortens surgery time but increases risks of correction loss and early radiographic PJK.
OBJECTIVE: To compare the clinical efficacy of long-segment vs. short-segment fixation in posterior osteotomy for kyphosis and identify factors affecting outcomes and complications.
METHODS: This retrospective controlled study included 150 patients undergoing posterior thoracolumbar osteotomy with fusion and internal fixation between June 2019 and June 2023. Patients were grouped by fixation length: long-segment (group L, ≥5 segments) and short-segment (group S, ≤4 segments). Propensity score matching balanced baseline characteristics, yielding 50 patients per group. Radiographic parameters (Cobb angle, sagittal vertical axis), perioperative data, and 12-month complications were recorded. Pain and function were assessed using VAS and ODI. Multivariate logistic regression identified independent risk factors for correction loss and early radiographic PJK.
RESULTS: Both groups showed significant postoperative improvement in Cobb angle and sagittal alignment (P < 0.05). Group L achieved a higher correction rate, lower Cobb angle loss, better VAS and ODI scores, and fewer early radiographic PJK and fixation-related complications (all P < 0.05). Group S had shorter operative time and less blood loss (P < 0.05), with no difference in other complications. Short-segment fixation was independent risk factors for correction loss and early radiographic PJK.
CONCLUSION: When correcting spinal kyphosis via posterior osteotomy, long-segment fixation better maintains correction and reduces complications like early radiographic PJK, while short-segment fixation shortens surgery time but increases risks of correction loss and early radiographic PJK.