{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T17:36:42Z","timestamp":1792863402362,"version":"4.5.0"},"reference-count":40,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare radiographic, clinical, and mechanical outcomes of posterior-only versus combined anterior\u2013posterior fusion in adult spinal deformity (ASD) patients undergoing long-segment thoracolumbar fusion with pelvic fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive ASD patients undergoing instrumented fusion \u22657 levels with pelvic fixation at a single center (2016\u20132023) were stratified by surgical approach. Longitudinal radiographic changes were analyzed using linear mixed-effects models with difference-in-differences (DiD) estimation. Mechanical complications were evaluated with Kaplan\u2013Meier survival and Cox proportional hazards analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>207 patients were included (posterior-only, n=115; combined, n=92). Mean age was 62.1 \u00b1 11.1 years (77.8% female), with mean follow-up of 46.2 \u00b1 21.2 months. The combined approach demonstrated significantly greater DiD estimates for lumbar lordosis (\u22127.8\u00b0 to \u22129.2\u00b0, all p&lt;0.001), relative pelvic version mismatch (+3.4\u00b0 to +4.2\u00b0, all p&lt;0.001), and GAP score (\u22121.8 to \u22122.1, all p&lt;0.001) at all postoperative timepoints. DiD estimates were stable across three covariate specifications. Rod fractures occurred in 14.8% of posterior-only versus 3.3% of combined patients (p=0.008), with superior rod fracture\u2013free survival in the combined cohort (log-rank p=0.019). In the primary Cox model, the combined approach showed a non-significant trend toward lower rod fracture hazard (HR 0.35, 95% CI 0.10\u20131.24, p=0.10). Patient-reported outcomes improved comparably in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In long-segment ASD fusion with pelvic fixation, the combined anterior\u2013posterior approach was associated with greater sustained sagittal correction and lower rod fracture rates, while both approaches provided comparable clinical improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261499343","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T23:59:48Z","timestamp":1792540788000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined Anterior\u2013Posterior vs. Posterior-Only Fusion in Adult Spinal Deformity Radiographic, Clinical, and Mechanical Outcomes With Longitudinal Mixed-Effects Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5820-1591","authenticated-orcid":false,"given":"Nuri","family":"Demirci","sequence":"first","affiliation":[{"name":"Hospital for Special Surgery"},{"name":"Washington University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A.","family":"Zaazoue","sequence":"additional","affiliation":[{"name":"University of Wisconsin\u2013Madison"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caglar","family":"Yilgor","sequence":"additional","affiliation":[{"name":"Koc University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasemin","family":"Yavuz","sequence":"additional","affiliation":[{"name":"Ankara University Faculty of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tugba","family":"Akkaya Hocagil","sequence":"additional","affiliation":[{"name":"Ankara University Faculty of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"R. Adams","family":"Cowley","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Pallotta","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish C.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery"},{"name":"Washington University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(19)31125-0"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-014-3542-1"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jspd.2015.12.009"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyz454"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000160842.43482.cd"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.3171\/2015.11.Spine151036"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.2106\/jbjs.23.00372"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000004414"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.2106\/jbjs.16.01594"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.3171\/2014.9.Spine131176"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.3171\/2014.2.Focus1422"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-021-06925-x"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.3171\/2016.10.Spine16849"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.3171\/2020.8.Spine201037"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.3171\/2019.7.Spine19630"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2018.02.008"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e3182672aab"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.3171\/2019.9.Spine19913"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-017-5084-9"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3182a51d43"},{"key":"e_1_3_8_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318271319c"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31824e4888"},{"key":"e_1_3_8_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31817c0428"},{"key":"e_1_3_8_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000169451.76359.49"},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-022-07249-0"},{"key":"e_1_3_8_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181c91163"},{"key":"e_1_3_8_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318067dc0e"},{"key":"e_1_3_8_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.08.067"},{"key":"e_1_3_8_30_2","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e31828bacd8"},{"key":"e_1_3_8_31_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v082.i13"},{"key":"e_1_3_8_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000000761"},{"key":"e_1_3_8_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2007.11.006"},{"key":"e_1_3_8_34_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v067.i01"},{"key":"e_1_3_8_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-011-1928-x"},{"key":"e_1_3_8_36_2","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000001116"},{"key":"e_1_3_8_37_2","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000000012"},{"key":"e_1_3_8_38_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000238968.82799.d9"},{"key":"e_1_3_8_39_2","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000000380"},{"key":"e_1_3_8_40_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13030682"},{"key":"e_1_3_8_41_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-024-08600-3"}],"container-title":["Global Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682261499343","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21925682261499343","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682261499343","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T16:59:13Z","timestamp":1792861153000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21925682261499343"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":40,"alternative-id":["10.1177\/21925682261499343"],"URL":"https:\/\/doi.org\/10.1177\/21925682261499343","relation":{},"ISSN":["2192-5682","2192-5690"],"issn-type":[{"value":"2192-5682","type":"print"},{"value":"2192-5690","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"article-number":"21925682261499343"}}