Achieving Correction and Mitigating Complications in Adult Spinal Deformity through an Anterior-Posterior Combined Approach

Abstract

Purpose To evaluate whether incorporating an anterior stage into adult spinal deformity (ASD) correction surgery with apical segment interbody fusion can reduce surgical invasiveness and enhance radiologic correction compared to a posterior-only approach. Materials and Methods A retrospective review was conducted using a prospectively collected database from a single institution. A total of 150 ASD patients who underwent surgery between January 2014 and May 2021 and were followed for at least 2 years were included. Among them, 108 underwent a posterior-only approach (P group), and 42 underwent a combined anterior-posterior approach (AP group). Radiologic outcomes, bone fusion rates, clinical outcomes, and complications were assessed at baseline, immediately postoperatively, and at 2 years postoperatively. Results The AP group received an average of 2.2±0.6 levels of interbody fusion at the deformity apex. Compared to the P group, the AP group had significantly lower Schwab grade of posterior osteotomy, reduced total blood loss, and shorter posterior operative time. The AP group demonstrated a significantly greater coronal correction of the major Cobb angle. Regarding sagittal balance, the AP group also achieved more harmonious alignment across most parameters throughout the 2-year follow-up, although the differences were not statistically significant. Clinical outcomes, complication rates, and fusion rates were comparable between the two groups. Conclusion Adding an anterior stage of apical segment interbody fusion to spinal deformity correction can achieve reduced surgical invasiveness and better spinal alignment without increasing the risk of major complications.