{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:48:10Z","timestamp":1792590490843,"version":"4.5.0"},"reference-count":26,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Whether a combined anterior\u2013posterior (AP) approach offers additional benefits over the posterior-only (P) approach in adult spinal deformity (ASD) surgery remains unknown. In a cohort of patients undergoing ASD surgery, we compared the combined AP vs. the P-only approach in: (1) preoperative\/perioperative variables, (2) radiographic measurements, and (3) postoperative outcomes. Methods: A single-institution, retrospective cohort study was performed for patients undergoing ASD surgery from 2009 to 2021. Inclusion criteria were \u22655-level fusion, sagittal\/coronal deformity, and 2-year follow-up. The primary exposure was the operative approach: a combined AP approach or P alone. Postoperative outcomes included mechanical complications, reoperation, and minimal clinically important difference (MCID), defined as 30% of patient-reported outcome measures (PROMs). Multivariable linear regression was controlled for age, BMI, and previous fusion. Results: Among 238 patients undergoing ASD surgery, 34 (14.3%) patients underwent the AP approach and 204 (85.7%) underwent the P-only approach. The AP group consisted mostly of anterior lumbar interbody fusion (ALIF) at L5\/S1 (73.5%) and\/or L4\/L5 (38.0%). Preoperatively, the AP group had more previous fusions (64.7% vs. 28.9%, p &lt; 0.001), higher pelvic tilt (PT) (29.6 \u00b1 11.6\u00b0 vs. 24.6 \u00b1 11.4\u00b0, p = 0.037), higher T1 pelvic angle (T1PA) (31.8 \u00b1 12.7\u00b0 vs. 24.0 \u00b1 13.9\u00b0, p = 0.003), less L1-S1 lordosis (\u221214.7 \u00b1 28.4\u00b0 vs. \u221224.3 \u00b1 33.4\u00b0, p &lt; 0.039), less L4-S1 lordosis (\u221225.4 \u00b1 14.7\u00b0 vs. 31.6 \u00b1 15.5\u00b0, p = 0.042), and higher sagittal vertical axis (SVA) (102.6 \u00b1 51.9 vs. 66.4 \u00b1 71.2 mm, p = 0.005). Perioperatively, the AP approach had longer operative time (553.9 \u00b1 177.4 vs. 397.4 \u00b1 129.0 min, p &lt; 0.001), more interbodies placed (100% vs. 17.6%, p &lt; 0.001), and longer length of stay (8.4 \u00b1 10.7 vs. 7.0 \u00b1 9.6 days, p = 0.026). Radiographically, the AP group had more improvement in T1PA (13.4 \u00b1 8.7\u00b0 vs. 9.5 \u00b1 8.6\u00b0, p = 0.005), L1-S1 lordosis (\u221214.3 \u00b1 25.6\u00b0 vs. \u22123.2 \u00b1 20.2\u00b0, p &lt; 0.001), L4-S1 lordosis (\u22124.7 \u00b1 16.4\u00b0 vs. 3.2 \u00b1 13.7\u00b0, p = 0.008), and SVA (65.3 \u00b1 44.8 vs. 44.8 \u00b1 47.7 mm, p = 0.007). These outcomes remained statistically significant in the multivariable analysis controlling for age, BMI, and previous fusion. Postoperatively, no significant differences were found in mechanical complications, reoperations, or MCID of PROMs. Conclusions: Preoperatively, patients undergoing the combined anterior\u2013posterior approach had higher PT, T1PA, and SVA and lower L1-S1 and L4-S1 lordosis than the posterior-only approach. Despite increased operative time and length of stay, the anterior\u2013posterior approach provided greater sagittal correction without any difference in mechanical complications or PROMs.<\/jats:p>","DOI":"10.3390\/jcm13030682","type":"journal-article","created":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T09:57:42Z","timestamp":1706090262000},"page":"682","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Combined Anterior\u2013Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior?"],"prefix":"10.3390","volume":"13","author":[{"given":"Iyan","family":"Younus","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Chanbour","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey W.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham W.","family":"Johnson","sequence":"additional","affiliation":[{"name":"School of Medicine, Vanderbilt University, Nashville, TN 37232, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Metcalf","sequence":"additional","affiliation":[{"name":"School of Medicine, Vanderbilt University, Nashville, TN 37232, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander T.","family":"Lyons","sequence":"additional","affiliation":[{"name":"School of Medicine, Vanderbilt University, Nashville, TN 37232, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soren","family":"Jonzzon","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Campbell","family":"Liles","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven G.","family":"Roth","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir M.","family":"Abtahi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"},{"name":"Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byron F.","family":"Stephens","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"},{"name":"Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA"},{"name":"Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"56","DOI":"10.22603\/ssrr.1.2016-0036","article-title":"Surgical treatment for adult spinal deformity: Conceptual approach and surgical strategy","volume":"1","author":"Matsuyama","year":"2017","journal-title":"Spine Surg. 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Spine"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/3\/682\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:48:44Z","timestamp":1760104124000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/3\/682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,24]]},"references-count":26,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["jcm13030682"],"URL":"https:\/\/doi.org\/10.3390\/jcm13030682","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,24]]}}}