Impact of adjunctive spine surgery on multilevel spinal fusion in the management of adult spinal deformity: A single centre propensity score-matched analysis

Adult Spinal Deformity (ASD) involves age-related lumbar degeneration and curvature. Treatment begins with therapy and pain management, but severe cases may need surgery. This study examines the impact of adjunctive spinal surgeries with fusion on surgical outcomes. This study reviewed ASD patients undergoing long-segment thoracolumbar fusion. Patients were classified as fusion-only or adjunctive (laminectomy plus fusion). Propensity score matching (PSM) adjusted for cohort parameters. Primary outcomes were analyzed across four domains: blood loss, functional recovery, hospital length of stay (LOS) and operative complications using standardized treatment effects. After PSM (Adjunctive, n = 82; Fusion-only, n = 34), no significant differences were observed in anesthesia duration, blood loss metrics, transfusion volumes, or postoperative Oswestry Disability Index improvements between groups. However, adjunctive surgery was associated with delayed postoperative initiation of walking (mean difference: 0.66 days, 95%CI: 0.19–1.14; p = 0.006) and reduced risk of hardware failure (RD: -0.11, 95%CI: -0.23, -0.0; p = 0.047). No differences were found in rates of infections, pseudarthrosis or overall complication. Adjunctive spine surgery showed delayed post-operative ambulation and reduced risk for hardware failure. However, functional improvement, overall complication rates and blood loss metrics were largely comparable. These findings suggest that adjunctive procedures may be safely performed when clinically indicated but should be selectively applied based on individual patient characteristics risk profiles and goals of surgery.