ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Limitations of fusion without pelvic foundation in adult spinal deformity surgery.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSignificant 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.
methodsSpinal 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.
resultsThe 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.
conclusionReferences 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.
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