complications and radiological findings in one-stage versus two-stage revision surgery for complex degenerative spinal deformities

Background: revision long-segment posterior spinal fusion (psf) for complex degenerative spinal deformity is technically demanding and associated with significant perioperative risks. whether a one-stage or two-stage strategy yields superior outcomes remains controversial. objectives: in this study, we aimed to compare radiologic outcomes, perioperative parameters, and complication rates between one-stage and two-stage revision of long-segment psf.methods: we retrospectively reviewed 45 patients who underwent revision long-segment psf at our tertiary center between 2021 and 2023. patients were divided into one-stage (n=29) and two-stage (n=16) groups. demographic, perioperative, and imaging parameters, as well as complication rates, were compared between groups. results: both groups demonstrated significant improvement in sagittal and coronal alignment, with no statistically significant differences in radiologic outcomes. operative time (p=0.038) and hemoglobin drop (p=0.001) were significantly greater in the two-stage group. hospital stay tended to be longer in staged procedures, though the difference was not statistically significant. overall complication rates were comparable between the groups (48.3% vs 37.5%, p=0.544), with infection being the most common complication in both groups (17.2% vs 18.7%).conclusion: one-stage and two-stage revision long-segment psf achieved comparable radiologic outcomes and complication rates. however, the one-stage approach was associated with shorter operative time and reduced hemoglobin drop. these findings suggest that single-stage revision surgery may provide favorable perioperative outcomes without compromising safety.