Skip to main content

Predictors and Correlative Factors for Low Back Pain after Long Fusion Arthrodesis in Patients with Adult Scoliosis



Low back pain (LBP) still exists at the follow-up visit in some cases after long fusion arthrodesis for adult scoliosis. However, few available studies have elaborated the reasons and factors associated with this symptom. Therefore, the aim of the current study was to identify the correlative factors and predictors of postoperative LBP after long fusion arthrodesis and provide evidence to improve the surgical strategy.


Seventy-nine patients with adult scoliosis who underwent long fusion arthrodesis were divided into a group with no or mild LBP (NLBP group) and one with moderate or severe LBP (MLBP group) according to the average Oswestry Dability Index (ODI) at the last follow-up visit. The Japanese Orthopaedic Association (JOA) score, ODI and complications were used to evaluate clinical outcomes. %Fat infltration area (%FIA), sagittal and coronal parameters were recorded to evaluate radiological outcomes. Multivariate logistic regression analysis was conducted to identify the predictors and correlative factors for postoperative LBP.


Thirty-three patients (41.77%) with ODI (30.06% ± 6.92%) higher than the average at the last follow-up were divided into the MLBP group, while the rest (58.23%) with last follow-up ODI (13.26% ± 5.31%) lower than the average were divided into the NLBP group. In multivariate logistic regression, the preoperative sagittal vertical axis (SVA) (P < 0.001), %FIA (P = 0.003) and osteoporosis (P = 0.016) were identified to be predictors and last follow-up SVA (P < 0.001), last follow-up lumbar lordosis (LL) (P = 0.031) and adjacent segment degeneration (ASD) (P = 0.043) were identified as correlative factors. The receiver-operating characteristic (ROC) curve showed satisfactory accuracy in preoperative SVA (P < 0.001) and %FIA (P < 0.001) to predict postoperative LBP.


Postoperative LBP after long fusion arthrodesis for adult scoliosis was common. Postoperative LBP was associated with increased SVA and decreased LL and ASD. Preoperative SVA > 3.54 cm, %FIA > 24.82% and osteoporosis showed good accuracy to predict the postoperative symptoms. Optimal surgical methods should be used for patients with these factors to decrease the incidence and degree of postoperative LBP.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Aebi M. The adult scoliosis. Eur Spine J. 2005;14(10):925–48.

    Article  Google Scholar 

  2. Phan K, Xu J, Maharaj MM, et al. Outcomes of short fusion versus long fusion for adult degenerative scoliosis: a systematic review and meta-analysis. OrthopSurg. 2017;9(4):342–9.

    Google Scholar 

  3. Eck KR, Bridwell KH, Ungacta FF, et al. Complications and results of long adult deformity fusions down to l4, l5, and the sacrum. Spine (Phila Pa 1976). 2001;26(9):E182–92.

    CAS  Article  Google Scholar 

  4. Edwards CC 2nd, Bridwell KH, Patel A, Rinella AS, Berra A, Lenke LG. Long adult deformity fusions to L5 and the sacrum. A matched cohort analysis. Spine (Phila Pa 1976). 2004;29(18):1996–2005.

    Article  Google Scholar 

  5. Kelly MP, Lurie JD, Yanik EL, et al. Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis. J Bone Joint Surg Am. 2019;101(4):338–52.

    Article  Google Scholar 

  6. Park HY, Kim YH, Kim SI, Han SB, Ha KY. Two different types of postoperative sagittal imbalance after long instrumented fusion to the sacrum for degenerative sagittal imbalance. J Neurosurg Spine. 2020;26:1–10.

    CAS  Google Scholar 

  7. Harding IJ, Charosky S, Vialle R, Chopin DH. Lumbar disc degeneration below a long arthrodesis (performed for scoliosis in adults) to L4 or L5. Eur Spine J. 2008;17:250–4.

    Article  Google Scholar 

  8. Gao X, Wang L, Zhang J, Wang P, Shen Y. Long fusion arthrodesis stopping at L5 for adult scoliosis: fate of L5–S1 disk and risk factors for subsequent disk degeneration. Clin Spine Surg. 2018;31(3):E171–7.

    Article  Google Scholar 

  9. Cho KJ, Suk SI, Park SR, et al. Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2010;35(17):1595–601.

    Article  Google Scholar 

  10. Theis J, Gerdhem P, Abbott A. Quality of life outcomes in surgically treated adult scoliosis patients: a systematic review. Eur Spine J. 2015;24(7):1343–55.

    Article  Google Scholar 

  11. Kyrölä K, Kautiainen H, Pekkanen L, Mäkelä P, Kiviranta I, Häkkinen A. Long-Term clinical and radiographic outcomes and patient satisfaction after adult spinal deformity correction. Scand J Surg. 2019;108(4):343–51.

    Article  Google Scholar 

  12. Mcdowell MM, Tempel ZJ, Gandhoke GS, et al. Evolution of sagittal imbalance following corrective surgery for sagittal plane deformity. Neurosurgery. 2017;81(1):129–34.

    Article  Google Scholar 

  13. Ghandhari H, AmeriMahabadi M, Nikouei F, et al. The role of spinopelvic parameters in clinical outcomes of spinal osteotomies in patients with sagittal imbalance. Arch Bone Jt Surg. 2018;6(4):324–30.

    PubMed  PubMed Central  Google Scholar 

  14. Xie D, Zhang J, Ding W, et al. Abnormal change of paravertebral muscle in adult degenerative scoliosis and its association with bony structural parameters. Eur Spine J. 2019;28(7):1626–37.

    Article  Google Scholar 

  15. Shafaq N, Suzuki A, Matsumura A, et al. Asymmetric degeneration of paravertebral muscles in patients with degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2012;37(16):1398–406.

    Article  Google Scholar 

  16. Bao H, Zhu F, Liu Z, et al. Coronal curvature and spinal imbalance in degenerative lumbar scoliosis: disc degeneration is associated. Spine (Phila Pa 1976). 2014;39(24):E1441–7.

    Article  Google Scholar 

  17. Yadla S, Maltenfort MG, Ratliff JK, Harrop JS. Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus. 2010;28(3):E3.

    Article  Google Scholar 

  18. Kalichman L, Carmeli E, Been E. The association between imaging parameters of the paraspinal muscles, spinal degeneration, and low back pain. Biomed Res Int. 2017;2017:2562957.

    Article  Google Scholar 

  19. Goubert D, Oosterwijck JV, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain: a systematic review. Pain Physician. 2016;19(7):E985–1000.

    PubMed  Google Scholar 

  20. McCoy S, Tundo F, Chidambaram S, Baaj AA. Clinical considerations for spinal surgery in the osteoporotic patient: a comprehensive review. Clin Neurol Neurosurg. 2019;180:40–7.

    CAS  Article  Google Scholar 

  21. Singh V, Mahajan R, Das K, Chhabra HS, Rustagi T. Surgical trend analysis for use of cement augmented pedicle screws in osteoporosis of spine: a systematic review (2000–2017). Global Spine J. 2019;9(7):783–95.

    Article  Google Scholar 

  22. Gazzeri R, Roperto R, Fiore C. Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study. J Neurosurg Spine. 2016;25(5):610–9.

    Article  Google Scholar 

  23. Cho KJ, Suk SI, Park SR, et al. Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2007;32(20):2232–7.

    Article  Google Scholar 

  24. Yagi M, Patel R, Boachie-Adjei O. Complications and unfavorable clinical outcomes in obese and overweight patients treated for adult lumbar or thoracolumbar scoliosis with combined anterior/posterior surgery. J Spinal Disord Tech. 2015;28(6):E368–76.

    Article  Google Scholar 

Download references


We thank the participants of the study.


This work was funded by the Natural Science Foundation of China (grant no. 8207090550). The journal’s Rapid Service Fee was funded by the authors.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authors’ Contributions

ZD and CHX designed the study. ZD, GXD and DWY collected data and performed the statistical analysis. ZD and CHX drafted the manuscript. All authors read and approved the final manuscript.


Di Zhang, Xianda Gao, Wenyuan Ding and Huixian Cui declare that they have no conflict of interest.

Compliance with Ethics Guidelines

This study was approved by the Institutional Ethics Board of the Third Hospital of Hebei Medical University (G2020-010-1), and the methods were carried out in accordance with the approved guidelines (Declaration of Helsinki and local clinical research regulations). Informed consent for clinical and imaging data was given by all participants.

Data Availability

The datasets used and/or analyzed during the present study are available from the corresponding author upon reasonable request.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Huixian Cui.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhang, D., Gao, X., Ding, W. et al. Predictors and Correlative Factors for Low Back Pain after Long Fusion Arthrodesis in Patients with Adult Scoliosis. Adv Ther 38, 3803–3815 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Adult
  • Arthrodesis
  • Low back pain
  • Postoperative complications
  • Scoliosis