Effectiveness of long-segment fixation versus short-segment fixation for treating adult degenerative scoliosis: A retrospective cohort study

The optimal fixation strategy for adult degenerative scoliosis (ADS), particularly in patients with mild to moderate curvature, remains controversial. This study aimed to compare the efficiency of long-segment fixation (LSF) versus short-segment fixation (SSF) in patients with Cobb angles between 10° and 30°. A retrospective cohort study was conducted involving 127 ADS patients who underwent posterior spinal fixation between June and December 2022. Patients were divided into the LSF group (>3 fixation segments, n = 71) and the SSF group (≤3 fixation segments, n = 56). Baseline characteristics, operative data, radiographic parameters, pain scores (Visual Analog Scale, VAS), functional status (Oswestry Disability Index, ODI), and complications were analyzed. LSF group was associated with significantly longer operative time, greater blood loss, and longer hospital stay compared to SSF (all P < 0.001). LSF group achieved significantly greater correction in Cobb angle, sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), and coronal balance distance (CBD) (all P < 0.05). Both groups showed significant improvement in leg and back pain and functional status, while the LSF group demonstrated a greater reduction in leg pain (VAS) and higher postoperative ODI scores compared to the SSF group (P < 0.05). The complication rate was higher in the LSF group (P = 0.030). Both LSF and SSF are effective in treating mild to moderate ADS. LSF offers superior alignment correction but with increased surgical risk. SSF provides comparable short-term outcomes with lower perioperative morbidity, supporting individualized surgical planning.