Objective: To evaluate 10-year outcomes after thoracic-to-pelvic corrective fusion for degenerative scoliosis and compare posterior-only corrective fusion (PCF) with staged fusion combined with lateral lumbar interbody fusion (LLIF; LIF group).

Methods: Single-center retrospective study of 57 patients (50 women) treated between 2011 and 2015; patients with Parkinson’s disease were excluded. Standing full-spine radiographs were assessed preoperatively and at 2 weeks, 2 years, 5 years, and 10 years. Oswestry Disability Index (ODI) was collected preoperatively and at 2, 5, and 10 years. Operative time, blood loss, complications, and reoperation were compared between PCF (n=35) and LIF (n=22)

Results: Mean age at surgery was 71.1 years; mean operative time 419 min, blood loss 1,492 mL, and fused levels 8.8. Follow-up rates were 91% (2 years), 81% (5 years), and 54% (10 years). Among 31 patients with 10-year radiographic follow-up, PI–LL (°) improved from 37.8 preoperatively to 5.4 at 2 weeks, 9.2 at 2 years, and 14.5 at 10 years. PT (°) improved from 33.7 to 19.7 at 2 weeks but increased to 27.2 at 10 years. SVA (mm) improved from 97.4 to 35.2 at 2 weeks but increased to 70.1 at 10 years. ODI (%) improved from 44.7 preoperatively to 28.0 (2 years), 23.4 (5 years), and 30.2 (10 years), maintaining significant improvement through 10 years. Reoperation occurred in 12 patients (38.7%). Operative time was longer in the LIF group, whereas blood loss was greater in the PCF group. LL and sacral slope at 2 weeks and ODI at 2 years were better in the LIF group; no group differences were observed after 5 years. Early reoperation within 3 months occurred in 4 PCF patients and none in the LIF group.

Conclusions: Thoracic-to-pelvic corrective fusion provided durable improvement in patient-reported outcomes despite partial long-term deterioration of alignment. LLIF-assisted staged surgery yielded superior early correction and short-term outcomes with fewer early reoperations, but 10-year outcomes were comparable to posterior-only fusion.