One-year CT evaluation of fusion in adult spinal deformity using supplemental anterior lumbar interbody fusion

Lærke C Ragborg; Martin Heegaard; Casper Dragsted; Emil Nielsen; Søren S Morgen; Benny Dahl; Martin Gehrchen

doi:10.1007/s00586-025-09150-y

One-year CT evaluation of fusion in adult spinal deformity using supplemental anterior lumbar interbody fusion

Lærke C Ragborg^*, Martin Heegaard, Casper Dragsted, Emil Nielsen, Søren S Morgen, Benny Dahl, Martin Gehrchen

^*Corresponding author for this work

Abstract

PURPOSE: The purpose of this study was to report the one-year posterior fusion rate in patients with adult spinal deformity (ASD) undergoing posterior spinal fusion (PSF) with supplemental lumbar interbody fusion (LIF).

METHODS: Patients with ASD who underwent PSF with supplemental ALIF and/or XLIF between October 2021 and December 2023 were prospectively enrolled. Fusion was assessed using fine-cut CT scans with Metal Artifact Reduction (MAR) and multi-planar reconstruction (MPR) one year after surgery, and each level was graded for interbody and posterolateral fusion (Glassman Classification). Interbody and posterolateral fusion were reported as individual fusion grades (1-4) and dichotomized as; Fusion (1-2) and non-fusion (3-4).

RESULTS: Of 57 enrolled patients, 50 had CT scans performed with 53 ALIF and 48 XLIF-treated levels. The mean age was 63.5 ± 11.6 years and 36 (72%) were female. Solid fusion of the interbody and/or posterolateral fusion assessed at the level of the LIF was obtained in 48 (96%) of the patients. Solid interbody fusion was significantly more frequent with ALIF; 49 (93%) compared to XLIF; 26 (54%) (p < 0.001). Additionally, the fusion score was significantly different with ALIF; median 1 [IQR 1-1] compared to XLIF median 2 [IQR 1-3] (p < 0.001). The posterolateral fusion rates did not differ significantly between ALIF (92%) and XLIF (88%) levels/segments (p = 0.470). Additionally, median Glassman scores for posterolateral fusion were similar: ALIF 1 [1, 1] vs. XLIF 1 [1, 2] (p = 0.370). Mechanical failure was observed in 9 patients (Displacement of the cage: 3, sacral screw loosening: 3, screw loosening: 1, rod breakage: 2) four of which were at the level of the LIF. Three patients underwent revision surgery at the level of the LIF.

CONCLUSION: Patients undergoing posterior instrumented fusion for ASD with supplemental anterior interbody fusion obtained high fusion rates assessed with CT. Higher rates of interbody fusion were observed in ALIF than in XLIF-treated levels. Despite differences in interbody fusion, similar posterolateral fusion was seen one year after surgery.

Original language	English
Journal	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
Volume	35
Issue number	1
Pages (from-to)	249-255
Number of pages	7
ISSN	0940-6719
DOIs	https://doi.org/10.1007/s00586-025-09150-y
Publication status	Published - Jan 2026

Keywords

Adult
Aged
Female
Humans
Lumbar Vertebrae/surgery
Male
Middle Aged
Prospective Studies
Spinal Curvatures/surgery
Spinal Fusion/methods
Tomography, X-Ray Computed
Adult spinal deformity
CT
ASD
ALIF
Lumbar interbody fusion
XLIF
Fusion

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Ragborg, L. C., Heegaard, M., Dragsted, C., Nielsen, E., Morgen, S. S., Dahl, B., & Gehrchen, M. (2026). One-year CT evaluation of fusion in adult spinal deformity using supplemental anterior lumbar interbody fusion. 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, 35(1), 249-255. https://doi.org/10.1007/s00586-025-09150-y

One-year CT evaluation of fusion in adult spinal deformity using supplemental anterior lumbar interbody fusion. / Ragborg, Lærke C ; Heegaard, Martin ; Dragsted, Casper et al.
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, Vol. 35, No. 1, 01.2026, p. 249-255.

Research output: Contribution to journal › Journal article › Research › peer-review

Ragborg, LC , Heegaard, M , Dragsted, C , Nielsen, E , Morgen, SS , Dahl, B & Gehrchen, M 2026, 'One-year CT evaluation of fusion in adult spinal deformity using supplemental anterior lumbar interbody fusion', 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, vol. 35, no. 1, pp. 249-255. https://doi.org/10.1007/s00586-025-09150-y

Ragborg LC , Heegaard M , Dragsted C , Nielsen E , Morgen SS , Dahl B et al. One-year CT evaluation of fusion in adult spinal deformity using supplemental anterior lumbar interbody fusion. 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 Jan;35(1):249-255. Epub 2025 Jul 29. doi: 10.1007/s00586-025-09150-y

Ragborg, Lærke C ; Heegaard, Martin ; Dragsted, Casper et al. / One-year CT evaluation of fusion in adult spinal deformity using supplemental anterior lumbar interbody fusion. 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 ; Vol. 35, No. 1. pp. 249-255.

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title = "One-year CT evaluation of fusion in adult spinal deformity using supplemental anterior lumbar interbody fusion",

abstract = "PURPOSE: The purpose of this study was to report the one-year posterior fusion rate in patients with adult spinal deformity (ASD) undergoing posterior spinal fusion (PSF) with supplemental lumbar interbody fusion (LIF).METHODS: Patients with ASD who underwent PSF with supplemental ALIF and/or XLIF between October 2021 and December 2023 were prospectively enrolled. Fusion was assessed using fine-cut CT scans with Metal Artifact Reduction (MAR) and multi-planar reconstruction (MPR) one year after surgery, and each level was graded for interbody and posterolateral fusion (Glassman Classification). Interbody and posterolateral fusion were reported as individual fusion grades (1-4) and dichotomized as; Fusion (1-2) and non-fusion (3-4).RESULTS: Of 57 enrolled patients, 50 had CT scans performed with 53 ALIF and 48 XLIF-treated levels. The mean age was 63.5 ± 11.6 years and 36 (72\%) were female. Solid fusion of the interbody and/or posterolateral fusion assessed at the level of the LIF was obtained in 48 (96\%) of the patients. Solid interbody fusion was significantly more frequent with ALIF; 49 (93\%) compared to XLIF; 26 (54\%) (p < 0.001). Additionally, the fusion score was significantly different with ALIF; median 1 [IQR 1-1] compared to XLIF median 2 [IQR 1-3] (p < 0.001). The posterolateral fusion rates did not differ significantly between ALIF (92\%) and XLIF (88\%) levels/segments (p = 0.470). Additionally, median Glassman scores for posterolateral fusion were similar: ALIF 1 [1, 1] vs. XLIF 1 [1, 2] (p = 0.370). Mechanical failure was observed in 9 patients (Displacement of the cage: 3, sacral screw loosening: 3, screw loosening: 1, rod breakage: 2) four of which were at the level of the LIF. Three patients underwent revision surgery at the level of the LIF.CONCLUSION: Patients undergoing posterior instrumented fusion for ASD with supplemental anterior interbody fusion obtained high fusion rates assessed with CT. Higher rates of interbody fusion were observed in ALIF than in XLIF-treated levels. Despite differences in interbody fusion, similar posterolateral fusion was seen one year after surgery.",

keywords = "Adult, Aged, Female, Humans, Lumbar Vertebrae/surgery, Male, Middle Aged, Prospective Studies, Spinal Curvatures/surgery, Spinal Fusion/methods, Tomography, X-Ray Computed, Adult spinal deformity, CT, ASD, ALIF, Lumbar interbody fusion, XLIF, Fusion",

author = "Ragborg, \{L{\ae}rke C\} and Martin Heegaard and Casper Dragsted and Emil Nielsen and Morgen, \{S{\o}ren S\} and Benny Dahl and Martin Gehrchen",

note = "{\textcopyright} 2025. The Author(s).",

year = "2026",

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doi = "10.1007/s00586-025-09150-y",

language = "English",

volume = "35",

pages = "249--255",

journal = "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",

issn = "0940-6719",

publisher = "Springer Science and Business Media Deutschland GmbH",

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T1 - One-year CT evaluation of fusion in adult spinal deformity using supplemental anterior lumbar interbody fusion

AU - Ragborg, Lærke C

AU - Heegaard, Martin

AU - Dragsted, Casper

AU - Nielsen, Emil

AU - Morgen, Søren S

AU - Dahl, Benny

AU - Gehrchen, Martin

PY - 2026/1

Y1 - 2026/1

N2 - PURPOSE: The purpose of this study was to report the one-year posterior fusion rate in patients with adult spinal deformity (ASD) undergoing posterior spinal fusion (PSF) with supplemental lumbar interbody fusion (LIF).METHODS: Patients with ASD who underwent PSF with supplemental ALIF and/or XLIF between October 2021 and December 2023 were prospectively enrolled. Fusion was assessed using fine-cut CT scans with Metal Artifact Reduction (MAR) and multi-planar reconstruction (MPR) one year after surgery, and each level was graded for interbody and posterolateral fusion (Glassman Classification). Interbody and posterolateral fusion were reported as individual fusion grades (1-4) and dichotomized as; Fusion (1-2) and non-fusion (3-4).RESULTS: Of 57 enrolled patients, 50 had CT scans performed with 53 ALIF and 48 XLIF-treated levels. The mean age was 63.5 ± 11.6 years and 36 (72%) were female. Solid fusion of the interbody and/or posterolateral fusion assessed at the level of the LIF was obtained in 48 (96%) of the patients. Solid interbody fusion was significantly more frequent with ALIF; 49 (93%) compared to XLIF; 26 (54%) (p < 0.001). Additionally, the fusion score was significantly different with ALIF; median 1 [IQR 1-1] compared to XLIF median 2 [IQR 1-3] (p < 0.001). The posterolateral fusion rates did not differ significantly between ALIF (92%) and XLIF (88%) levels/segments (p = 0.470). Additionally, median Glassman scores for posterolateral fusion were similar: ALIF 1 [1, 1] vs. XLIF 1 [1, 2] (p = 0.370). Mechanical failure was observed in 9 patients (Displacement of the cage: 3, sacral screw loosening: 3, screw loosening: 1, rod breakage: 2) four of which were at the level of the LIF. Three patients underwent revision surgery at the level of the LIF.CONCLUSION: Patients undergoing posterior instrumented fusion for ASD with supplemental anterior interbody fusion obtained high fusion rates assessed with CT. Higher rates of interbody fusion were observed in ALIF than in XLIF-treated levels. Despite differences in interbody fusion, similar posterolateral fusion was seen one year after surgery.

AB - PURPOSE: The purpose of this study was to report the one-year posterior fusion rate in patients with adult spinal deformity (ASD) undergoing posterior spinal fusion (PSF) with supplemental lumbar interbody fusion (LIF).METHODS: Patients with ASD who underwent PSF with supplemental ALIF and/or XLIF between October 2021 and December 2023 were prospectively enrolled. Fusion was assessed using fine-cut CT scans with Metal Artifact Reduction (MAR) and multi-planar reconstruction (MPR) one year after surgery, and each level was graded for interbody and posterolateral fusion (Glassman Classification). Interbody and posterolateral fusion were reported as individual fusion grades (1-4) and dichotomized as; Fusion (1-2) and non-fusion (3-4).RESULTS: Of 57 enrolled patients, 50 had CT scans performed with 53 ALIF and 48 XLIF-treated levels. The mean age was 63.5 ± 11.6 years and 36 (72%) were female. Solid fusion of the interbody and/or posterolateral fusion assessed at the level of the LIF was obtained in 48 (96%) of the patients. Solid interbody fusion was significantly more frequent with ALIF; 49 (93%) compared to XLIF; 26 (54%) (p < 0.001). Additionally, the fusion score was significantly different with ALIF; median 1 [IQR 1-1] compared to XLIF median 2 [IQR 1-3] (p < 0.001). The posterolateral fusion rates did not differ significantly between ALIF (92%) and XLIF (88%) levels/segments (p = 0.470). Additionally, median Glassman scores for posterolateral fusion were similar: ALIF 1 [1, 1] vs. XLIF 1 [1, 2] (p = 0.370). Mechanical failure was observed in 9 patients (Displacement of the cage: 3, sacral screw loosening: 3, screw loosening: 1, rod breakage: 2) four of which were at the level of the LIF. Three patients underwent revision surgery at the level of the LIF.CONCLUSION: Patients undergoing posterior instrumented fusion for ASD with supplemental anterior interbody fusion obtained high fusion rates assessed with CT. Higher rates of interbody fusion were observed in ALIF than in XLIF-treated levels. Despite differences in interbody fusion, similar posterolateral fusion was seen one year after surgery.

KW - Adult

KW - Aged

KW - Female

KW - Humans

KW - Lumbar Vertebrae/surgery

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Spinal Curvatures/surgery

KW - Spinal Fusion/methods

KW - Tomography, X-Ray Computed

KW - Adult spinal deformity

KW - CT

KW - ASD

KW - ALIF

KW - Lumbar interbody fusion

KW - XLIF

KW - Fusion

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U2 - 10.1007/s00586-025-09150-y

DO - 10.1007/s00586-025-09150-y

M3 - Journal article

C2 - 40728665

SN - 0940-6719

VL - 35

SP - 249

EP - 255

JO - 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

JF - 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

IS - 1

ER -

One-year CT evaluation of fusion in adult spinal deformity using supplemental anterior lumbar interbody fusion

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