Effect of one- or two-level posterior lumbar interbody fusion on global sagittal balance

Global sagittal balance improved after short-level lumbar fusion surgery in patients having spinal stenosis with spondylolisthesis who showed preoperative sagittal imbalance. Restoration of sagittal balance predominantly occurred after L3-L4, L4-L5, or L3-L5 PLIF. However, no such restoration was observed after L5-S1 or L4-S1 PLIF. Thus, we could anticipate sagittal balance restoration after performing PLIF at L3-L4 or L4-L5 level. However, caution is required when planning for L5-S1 fusion if preoperative sagittal imbalance is present.