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Introduction <p>Significant spinal corrections require a rigid pelvic foundation (PF) and back muscles related to sagittal alignment. However, criteria for deformity or muscular volume that allow fusion without a PF are lacking. This study aims to assess the feasibility of achieving fusion-ending lumbar spine, focusing on preoperative alignment and back muscle condition, and to analyze how poor alignment progresses over 2 years and the related mechanical failure.</p> Methods <p>Spinal instrumentations involving ≥ 4 levels from thoracolumbar to L5 were categorized from the 2-year sagittal vertical axis (SVA) into Group F (≥ 50&#xa0;mm) and Group S (&lt; 50&#xa0;mm). Differences in radiographic measurements (sagittal modifiers, L1/T4 pelvic angles, and others), cross-sectional areas of the multifidus/erector spinae muscles, and mechanical failure rates were evaluated.</p> Results <p>The study included 105 patients (average age 70.1 years; 65.7% female), with 60 in Group F and 45 in Group S, averaging 5.8 fused levels. Preoperative sagittal alignment improved postoperatively. Group F had worse postoperative SVA than Group S and showed deterioration over 2 years. Preoperative alignment and multifidus were correlated with 2-year SVA, and multivariate analysis identified significant factors, with cutoff values of 92&#xa0;mm for SVA and 335&#xa0;mm² for multifidus. Additionally, Group F showed a higher rate of mechanical failure.</p> Conclusion <p>References for spinal restoration without PF were evaluated from preoperative alignments and back muscle conditions. Patients who cannot maintain proper alignment for even 2 years might require fusion with a PF to ensure better long-term alignment and prevent mechanical failure.</p>

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Limitations of fusion without pelvic foundation in adult spinal deformity surgery

  • 期刊论文

  • 发表日期：

    2025年10月10日

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  • Yoshinori Ishikawa,
  • Eiji Abe,
  • Takashi Kobayashi,
  • Naohisa Miyakoshi

摘要

Introduction

Significant spinal corrections require a rigid pelvic foundation (PF) and back muscles related to sagittal alignment. However, criteria for deformity or muscular volume that allow fusion without a PF are lacking. This study aims to assess the feasibility of achieving fusion-ending lumbar spine, focusing on preoperative alignment and back muscle condition, and to analyze how poor alignment progresses over 2 years and the related mechanical failure.

Methods

Spinal instrumentations involving ≥ 4 levels from thoracolumbar to L5 were categorized from the 2-year sagittal vertical axis (SVA) into Group F (≥ 50 mm) and Group S (< 50 mm). Differences in radiographic measurements (sagittal modifiers, L1/T4 pelvic angles, and others), cross-sectional areas of the multifidus/erector spinae muscles, and mechanical failure rates were evaluated.

Results

The study included 105 patients (average age 70.1 years; 65.7% female), with 60 in Group F and 45 in Group S, averaging 5.8 fused levels. Preoperative sagittal alignment improved postoperatively. Group F had worse postoperative SVA than Group S and showed deterioration over 2 years. Preoperative alignment and multifidus were correlated with 2-year SVA, and multivariate analysis identified significant factors, with cutoff values of 92 mm for SVA and 335 mm² for multifidus. Additionally, Group F showed a higher rate of mechanical failure.

Conclusion

References for spinal restoration without PF were evaluated from preoperative alignments and back muscle conditions. Patients who cannot maintain proper alignment for even 2 years might require fusion with a PF to ensure better long-term alignment and prevent mechanical failure.