A Retrospective Comparative Study of Early and Mid-to Long-Term Clinical Efficacy and Spinopelvic Sagittal Alignment After Multisegment PLIF with Different Degrees of Sagittal Correction

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.