{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T21:33:34Z","timestamp":1780349614705,"version":"3.54.1"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"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>Objectives: The aim of this study was to compare the radiographic results, mechanical complications, and clinical outcomes between anterior and posterior lumbar interbody fusion at L5\u2013S1 (ALIF51 and PLIF51 groups, respectively) using a matched cohort of patients undergoing long fusion for adult spinal deformity (ASD). Methods: Patients who underwent hybrid surgery of \u22655-level fusion to the pelvis with a minimum follow-up duration of 2 years were included. The baseline characteristics of the groups were controlled using a propensity score matching analysis. The radiographic results, mechanical complications such as proximal junctional kyphosis\/failure and metal failure, and clinical outcomes were compared between the groups. Results: In total, 79 patients were assigned to each group with comparable baseline data, except for a higher frequency of anterior column realignment procedures in the PLIF51 group than in the ALIF51 group (49.4% vs. 31.6%). At the last follow-up, L5\u2013S1 segmental lordosis (SL) was significantly greater in the ALIF51 group than in the PLIF51 group (12.1\u00b0 vs. 7.3\u00b0, p &lt; 0.001). The final C7\u2013sagittal vertical axis (SVA) was significantly smaller in the ALIF51 group than in the PLIF51 group (25.4 mm vs. 35.5 mm, p = 0.032). However, other global sagittal parameters were comparable between the groups. The mechanical complication rates, including metal failure at L5\u2013S1, and the final clinical outcomes were comparable between the groups. Conclusions: ALIF51 has modest advantages over PLIF51 in terms of better restoring L5\u2013S1 SL and C7\u2013SVA with avoiding more invasive procedures above the L5\u2013S1 levels. Other sagittal parameters, mechanical complication rates, and clinical outcomes did not differ between the groups.<\/jats:p>","DOI":"10.3390\/jcm14051431","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T11:03:37Z","timestamp":1740049417000},"page":"1431","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Anterior Versus Posterior Lumbar Interbody Fusion at L5-S1 in Hybrid Surgery for Adult Spinal Deformity: A Propensity Score Matching Analysis of Radiographic Results, Mechanical Complications, and Clinical Outcomes"],"prefix":"10.3390","volume":"14","author":[{"given":"Se-Jun","family":"Park","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9114-0150","authenticated-orcid":false,"given":"Dong-Ho","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6517-8609","authenticated-orcid":false,"given":"Jin-Sung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2719-1989","authenticated-orcid":false,"given":"Minwook","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong-Suh","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan 48094, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2224-604X","authenticated-orcid":false,"given":"Kyunghun","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"776","DOI":"10.31616\/asj.2022.0376","article-title":"Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions","volume":"16","author":"Kim","year":"2022","journal-title":"Asian Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"890","DOI":"10.31616\/asj.2021.0354","article-title":"Multicenter Prospective Study of Lateral Lumbar Interbody Fusions Using Bioactive Porous Titanium Spacers without Bone Grafts","volume":"16","author":"Fujibayashi","year":"2022","journal-title":"Asian Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"421","DOI":"10.31616\/asj.2019.0357","article-title":"Surgical Outcomes of Multilevel Posterior Lumbar Interbody Fusion versus Lateral Lumbar Interbody Fusion for the Correction of Adult Spinal Deformity: A Comparative Clinical Study","volume":"14","author":"Iwamae","year":"2020","journal-title":"Asian Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1177\/21925682221089876","article-title":"What Are the Benefits of Lateral Lumbar Interbody Fusion on the Treatment of Adult Spinal Deformity: A Systematic Review and Meta-Analysis Deformity","volume":"13","author":"Yang","year":"2023","journal-title":"Glob. Spine J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"E192","DOI":"10.1097\/BSD.0000000000001566","article-title":"Pedicle Subtraction Osteotomy Versus Multilevel Anterior Lumbar Interbody Fusion and Lateral Lumbar Interbody Fusion in the Treatment of Adult Spinal Deformity: Trends, Outcomes, and Cost","volume":"37","author":"Chi","year":"2024","journal-title":"Clin. Spine Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1093\/neuros\/nyaa469","article-title":"Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity","volume":"88","author":"Park","year":"2021","journal-title":"Neurosurgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"420","DOI":"10.3171\/2022.1.SPINE211000","article-title":"L5-S1 nonunion occurrence even after anterior column support combined with iliac screw fixation in long fusion for adult spinal deformity: CT-based analysis at 2-year follow-up","volume":"37","author":"Park","year":"2022","journal-title":"J. Neurosurg. Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E206","DOI":"10.1097\/BRS.0b013e3181bfa518","article-title":"Critical length of fusion requiring additional fixation to prevent nonunion of the lumbosacral junction","volume":"35","author":"Lee","year":"2010","journal-title":"Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/j.jos.2020.08.005","article-title":"Single-level controlled comparison of OLIF51 and percutaneous screw in lateral position versus MIS-TLIF for lumbosacral degenerative disorders: Clinical and radiologic study","volume":"26","author":"Kotani","year":"2021","journal-title":"J. Orthop. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1097\/BRS.0000000000004333","article-title":"ALIF Versus TLIF for L5-S1 Isthmic Spondylolisthesis: ALIF Demonstrates Superior Segmental and Regional Radiographic Outcomes and Clinical Improvements Across More Patient-reported Outcome Measures Domains","volume":"47","author":"Lightsey","year":"2022","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Kotani, Y., Ikeura, A., Tanaka, T., and Saito, T. (2024). Clinical and Radiologic Analysis of Minimally Invasive Anterior-Posterior Combined Surgery for Adult Spinal Deformity: Comparison of Oblique Lateral Interbody Fusion at L5\/S1 (OLIF51) versus Transforaminal Interbody Fusion. Medicina, 60.","DOI":"10.3390\/medicina60010107"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1177\/2192568220921833","article-title":"Does L5-S1 Anterior Lumbar Interbody Fusion Improve Sagittal Alignment or Fusion Rates in Long Segment Fusion for Adult Spinal Deformity?","volume":"11","author":"Meyers","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e1265","DOI":"10.1016\/j.wneu.2023.04.113","article-title":"L5-S1 Pseudoarthrosis Rate with ALIF Versus TLIF in Adult Spinal Deformity Surgeries: A Retrospective Analysis of 100 Patients","volume":"175","author":"Singh","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"42","DOI":"10.3171\/2019.7.SPINE19630","article-title":"Comparison of rod fracture rates in long spinal deformity constructs after transforaminal versus anterior lumbar interbody fusions: A single-institution analysis","volume":"32","author":"Adogwa","year":"2020","journal-title":"J. Neurosurg. Spine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.2106\/JBJS.16.01594","article-title":"Global Alignment and Proportion (GAP) Score: Development and Validation of a New Method of Analyzing Spinopelvic Alignment to Predict Mechanical Complications After Adult Spinal Deformity Surgery","volume":"99","author":"Yilgor","year":"2017","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s43390-021-00397-1","article-title":"Sagittal age-adjusted score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications","volume":"10","author":"Lafage","year":"2022","journal-title":"Spine Deform."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1643","DOI":"10.1097\/01.brs.0000169451.76359.49","article-title":"Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: Incidence, outcomes, and risk factor analysis","volume":"30","author":"Glattes","year":"2005","journal-title":"Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1097\/BRS.0000000000004672","article-title":"Minimum Clinically Important Difference in Patient-reported Outcome Measures in de novo Degenerative Lumbar Scoliosis: Is it Appropriate to Apply the Values of Adult Spine Deformity?","volume":"48","author":"Yuan","year":"2023","journal-title":"Spine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"723","DOI":"10.3340\/jkns.2018.0215","article-title":"Usefulness of Oblique Lateral Interbody Fusion at L5-S1 Level Compared to Transforaminal Lumbar Interbody Fusion","volume":"63","author":"Mun","year":"2020","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1097\/BRS.0000000000004404","article-title":"A Complement Type to SRS-Schwab Adult Spinal Deformity Classification: The Failure of Pelvic Compensation","volume":"47","author":"Kwon","year":"2022","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"476","DOI":"10.3171\/2012.8.SPINE111121","article-title":"Lordosis restoration after anterior longitudinal ligament release and placement of lateral hyperlordotic interbody cages during the minimally invasive lateral transpsoas approach: A radiographic study in cadavers","volume":"17","author":"Uribe","year":"2012","journal-title":"J. Neurosurg. Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"530","DOI":"10.3171\/2012.8.SPINE12432","article-title":"Anterior longitudinal ligament release using the minimally invasive lateral retroperitoneal transpsoas approach: A cadaveric feasibility study and report of 4 clinical cases","volume":"17","author":"Deukmedjian","year":"2012","journal-title":"J. Neurosurg. Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e379","DOI":"10.1016\/j.wneu.2018.11.174","article-title":"Anterior Column Realignment in Adult Spinal Deformity: A Case Report and Review of the Literature","volume":"123","author":"Cheung","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/BRS.0000000000005114","article-title":"Incidence and Risk Factors for Mechanical Failure After Anterior Column Realignment in Adult Spinal Deformity Surgery","volume":"50","author":"Park","year":"2025","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"729","DOI":"10.3171\/2020.11.SPINE201915","article-title":"Multicenter assessment of outcomes and complications associated with transforaminal versus anterior lumbar interbody fusion for fractional curve correction","volume":"35","author":"Buell","year":"2021","journal-title":"J. Neurosurg. Spine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1097\/BRS.0b013e31823e15e2","article-title":"Scoliosis Research Society-Schwab adult spinal deformity classification: A validation study","volume":"37","author":"Schwab","year":"2012","journal-title":"Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"E599","DOI":"10.1097\/BRS.0b013e3181aad219","article-title":"Pelvic tilt and truncal inclination: Two key radiographic parameters in the setting of adults with spinal deformity","volume":"34","author":"Lafage","year":"2009","journal-title":"Spine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.2106\/JBJS.M.01459","article-title":"The T1 Pelvic Angle, a Novel Radiographic Measure of Global Sagittal Deformity, Accounts for Both Spinal Inclination and Pelvic Tilt and Correlates with Health-Related Quality of Life","volume":"96","author":"Protopsaltis","year":"2014","journal-title":"J. Bone Jt. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1007\/s11999.0000000000000264","article-title":"Classification in Brief: SRS-Schwab Classification of Adult Spinal Deformity","volume":"476","author":"Slattery","year":"2018","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jocn.2020.10.043","article-title":"Supine anterior lumbar interbody fusion versus lateral position oblique lumbar interbody fusion at L5-S1: A comparison of two approaches to the lumbosacral junction","volume":"82","author":"Xi","year":"2020","journal-title":"J. Clin. Neurosci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1431\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:39:09Z","timestamp":1760027949000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,20]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14051431"],"URL":"https:\/\/doi.org\/10.3390\/jcm14051431","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,20]]}}}