# Comparison of short-segment vs. long-segment fixation in posterior osteotomy for kyphotic deformity: effects on postoperative alignment and complications

## TL;DR

Long-segment spinal fixation after surgery for kyphosis improves correction and reduces complications compared to short-segment fixation, though it takes longer.

## Contribution

This study compares long-segment and short-segment fixation in kyphosis surgery, identifying their effects on correction and complications.

## Key findings

- Long-segment fixation achieved better correction and fewer complications like early PJK.
- Short-segment fixation had shorter surgery time but higher risk of correction loss and PJK.
- Short-segment fixation was an independent risk factor for correction loss and early PJK.

## Abstract

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.

To compare the clinical efficacy of long-segment vs. short-segment fixation in posterior osteotomy for kyphosis and identify factors affecting outcomes and complications.

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.

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.

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.