{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T18:10:44Z","timestamp":1780078244988,"version":"3.54.0"},"reference-count":37,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hainan Provincial Natural Science","award":["821MS160"],"award-info":[{"award-number":["821MS160"]}]},{"name":"Hainan Province Health Commission","award":["20A200517"],"award-info":[{"award-number":["20A200517"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: Posterior lumbar interbody fusion (PLIF), posterolateral fusion (PLF), and Hybrid fusion are widely used fusion procedures for lumbar degenerative diseases (LDDs). Postoperative complications dominated by cage migration (CM) and adjacent segment degeneration (ASD) remain major challenges. This study aimed to identify and compare the independent risk factors for CM and ASD in PLIF, PLF, and Hybrid fusion, so as to provide evidence-based references for preoperative evaluation, surgical selection, and complication prevention in clinical practice. Methods: A retrospective cohort study was conducted in patients who underwent PLIF, PLF, or Hybrid fusion for LDDs at our institution. Demographic data (age, gender, and body mass index [BMI]), lifestyle factors (smoking and insobriety), comorbidities (hypertension, diabetes, hyperuricemia, osteoporosis, and hypoalbuminemia), surgical parameters (operative time, intraoperative blood loss, fusion segments, and lumbar lordosis angle), radiological indices (Pfirrmann grading of intervertebral disc degeneration and relative disc height), and biological markers (C-reactive protein\/lymphocyte ratio [CLR], procalcitonin [PCT], and serum amyloid A [SAA]) were collected. Patients were stratified into complication and non-complication groups based on the occurrence of CM or ASD. Univariate and binary logistic regression analyses were performed to determine independent risk factors for postoperative complications. Results: A total of 203 patients were enrolled, including 80 cases with complications in the PLIF group, 64 in the Hybrid group, and 59 in the PLF group. No significant differences were noted in the distribution of complication types among the three groups (p = 0.179). Univariate analysis revealed that BMI, osteoporosis, the Pfirrmann grading of superior adjacent disc degeneration, lumbar lordosis angle, operative time, and intraoperative blood loss were significantly associated with postoperative complications across all three surgical groups (p &lt; 0.05). Binary logistic regression analysis confirmed that elevated BMI (PLIF: OR = 1.18, 95%CI: 1.05\u20134.38; PLF: OR = 1.19, 95%CI: 0.76\u20132.18; Hybrid: OR = 1.14, 95%CI: 1.07\u20132.54), osteoporosis (PLIF: OR = 6.86; PLF: OR = 7.62; Hybrid: OR = 5.62), advanced superior adjacent disc degeneration (PLIF: OR = 8.04; PLF: OR = 4.49; Hybrid: OR = 2.87), prolonged operative time, and increased intraoperative blood loss were independent risk factors for postoperative complications. In contrast, age, gender, smoking, insobriety, hypertension, diabetes, CLR, PCT, and SAA were not identified as risk factors (p* &gt; 0.05). Conclusions: Elevated BMI, osteoporosis, pre-existing superior adjacent disc degeneration, prolonged operative time, and increased intraoperative blood loss are shared independent risk factors for CM and ASD following PLIF, PLF, and Hybrid fusion for LDDs. Targeted interventions addressing these factors may reduce postoperative complication rates and improve patient outcomes.<\/jats:p>","DOI":"10.3390\/jcm15114195","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T17:36:18Z","timestamp":1780076178000},"page":"4195","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors for Postoperative Complications in Different Fusion Surgical Approaches for Lumbar Degenerative Diseases"],"prefix":"10.3390","volume":"15","author":[{"given":"Zhenbiao","family":"Zhu","sequence":"first","affiliation":[{"name":"The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou 510515, China"},{"name":"Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China"},{"name":"Department of Orthopaedics, Haikou Research Institute of Xiangya School of Medicine, Central South University, Haikou 570208, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anwu","family":"Xuan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China"},{"name":"Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110015, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaofeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Xi\u2019an Honghui Hospital, Xi\u2019an 710054, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"He","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Tang","sequence":"additional","affiliation":[{"name":"The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou 510515, China"},{"name":"Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9642-3096","authenticated-orcid":false,"given":"Dike","family":"Ruan","sequence":"additional","affiliation":[{"name":"The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou 510515, China"},{"name":"Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1186\/s13018-020-02051-4","article-title":"Perioperative hypoalbuminemia is a risk factor for wound complications following posterior lumbar interbody fusion","volume":"15","author":"He","year":"2020","journal-title":"J. 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