What question did this study set out to answer?

This research aims to compare the outcomes of combined anterior-posterior versus posterior-only instrumented fusion for adult spinal deformity.

April 5, 2026Open Access

Comparison of the Combined and Posterior Approaches for Adult Spinal Deformity: A Meta-Analysis

Key Points

This research aims to compare the outcomes of combined anterior-posterior versus posterior-only instrumented fusion for adult spinal deformity.
Systematic review and meta-analysis conducted.
Data sourced from PubMed, Cochrane Library, Scopus, and Embase from January 2000 to February 2025.
Included studies involved comparisons of combined and posterior instrumented fusion techniques in adult spinal deformity.
Operative time, blood loss, fusion levels, sagittal vertical axis, Cobb angle, complications, and Oswestry Disability Index were analyzed.
Mean operative time was significantly shorter in the posterior group (WMD=-99.73 minutes, p=0.01).
Mean blood loss was significantly lower in the combined group (WMD=664.69 mL, p=0.03).
No significant differences were found in number of fused levels, sagittal vertical axis, Cobb angle, or complication rates.
Preoperative and postoperative Oswestry Disability Index scores did not differ significantly between the groups.

Abstract

Study Design: Systematic review and meta-analysis.Objectives: This study aimed to compare the clinical and radiological outcomes of combined anterior-posterior instrumented fusion (anterior lumbar interbody fusion ALIF or lateral lumbar interbody fusion LLIF with posterior pedicle screw fixation) and posterior-only instrumented fusion (transforaminal lumbar interbody fusion TLIF, posterior lumbar interbody fusion PLIF, or osteotomy) in adult spinal deformity (ASD).Summary of Literature Review: Although both combined and posterior approaches are widely used for correction of ASD, evidence comparing their relative efficacy and surgical burden remains limited.Previous studies have reported conflicting results regarding their effects on operative time, blood loss, and postoperative alignment.Materials and Methods: A systematic search of PubMed, Cochrane Library, Scopus, and Embase was conducted for studies published between January 2000 and February 2025.Comparative studies evaluating combined and posterior instrumented fusion for ASD were included.Data on operative time, blood loss, fusion levels, sagittal vertical axis (SVA), Cobb angle, complications, and Oswestry Disability Index (ODI) were extracted and analyzed using RevMan 5.2.Weighted mean differences (WMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.Results: Nine studies were included in the meta-analysis.Mean operative time was significantly shorter in the posterior group (WMD=-99.73minutes, 95% CI: -179.02 to -20.44, p=0.01), whereas mean blood loss was significantly lower in the combined group (WMD=664.69mL, 95% CI: 78.46 to 1250.92, p=0.03).No significant between-group differences were found in the number of fused levels (WMD=0.87,p=0.29), preoperative or postoperative SVA (WMD=-2.66 mm and 12.59 mm, respectively; p>0.05), or Cobb angle (preoperative WMD=-1.85 and postoperative WMD=-0.41;p>0.05).Complication rates, including neurological deficit and pseudoarthrosis, as well as preoperative and postoperative ODI scores, did not differ significantly between the groups.Conclusions: No clear clinical or radiological superiority was identified between the two techniques.Therefore, surgical decisionmaking should be individualized by balancing the shorter operative time associated with the posterior approach against the reduced

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Cite This Study

Kim et al. (Thu,) studied this question.

synapsesocial.com/papers/69d1fc4fa79560c99a0a1df8 https://doi.org/https://doi.org/10.4184/jkss.2026.33.1.5

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