Neurosurgery 97:821–828, 2025
Despite radiographic success in adult spinal deformity surgery, 24.1% of patients remained dissatisfied, mainly due to postoperative lumbar stiffness-related disability. Satisfaction was not linked to radiographic parameters but was independently predicted by the modified lumbar stiffness disability index, highlighting the importance of counseling patients about this trade-off.
• About 24.1% of patients were dissatisfied with adult spinal deformity (ASD) surgery despite radiographic success.
• Radiographic success was defined as optimal alignment, no mechanical complications, and no revision surgery.
• Patient satisfaction was measured using SRS-22; scores <4.0 indicated less satisfaction.
• Clinical outcomes (pain, disability, quality of life) improved after surgery, but lumbar stiffness (M-LSDI) worsened.
• No significant differences in radiographic parameters were found between satisfied and less satisfied groups.
• High postoperative lumbar stiffness (M-LSDI score) was the single independent risk factor for dissatisfaction.
• Longer fusion length was associated with higher lumbar stiffness and lower satisfaction.
• Patients should be informed about the trade-off between pain relief and increased lumbar stiffness before surgery.
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