ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
Comparison of Short-Segment Versus Long-Segment Fixation in Posterior Osteotomy for Kyphotic Deformity: Effects on Postoperative Alignment and Complications
Provisionally accepted
- North China Medical and Health Group Xingtai General Hospital, Xingtai City, China
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Background: Posterior osteotomy is an effective treatment for severe kyphosis; however, postoperative complications, particularly early radiographic proximal junctional kyphosis (PJK), may compromise outcomes. Evidence regarding factors influencing postoperative efficacy and complication risk remains limited. Objective: To compare the clinical efficacy of long-segment versus short-segment fixation in posterior osteotomy for kyphosis and identify factors affecting outcomes and complications. Methods: This retrospective controlled study included 150 patients undergoing posterior thoracolumbar osteotomy with fusion and internal fixation between June 2019 and June 2023. Patients were grouped by fixation length: long-segment (group L, ≥5 segments) and short-segment (group S, ≤4 segments). Propensity score matching balanced baseline characteristics, yielding 50 patients per group. Radiographic parameters (Cobb angle, sagittal vertical axis), perioperative data, and 12-month complications were recorded. Pain and function were assessed using VAS and ODI. Multivariate logistic regression identified independent risk factors for correction loss and early radiographic PJK. Results: Both groups showed significant postoperative improvement in Cobb angle and sagittal alignment (P<0.05). Group L achieved a higher correction rate, lower Cobb angle loss, better VAS and ODI scores, and fewer early radiographic PJK and fixation-related complications (all P<0.05). Group S had shorter operative time and less blood loss (P<0.05), with no difference in other complications. Short-segment fixation was independent risk factors for correction loss and early radiographic PJK. Conclusion: When correcting spinal kyphosis via posterior osteotomy, long-segment fixation better maintains correction and reduces complications like early radiographic PJK, while junctional kyphosis 删除[Author]: junctional kyphosis 删除[Author]: junctional kyphosis 删除[Author]: , BMD T-score <−2.5, and age >60 years 删除[Author]: ere 删除[Author]: junctional kyphosis 删除[Author]: short-segment fixation shortens surgery time but increases risks of correction loss and early radiographic PJK.
Keywords: Kyphotic deformity, Long-segment fixation, Osteotomy, posterior osteotomy, Short-SegmentFixation
Received: 19 Dec 2025; Accepted: 19 Jan 2026.
Copyright: © 2026 Zhao, Yuan, Zhang, Chen, Zhang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qiang Li
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