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SA changes were more substantial after CPS fixation, with a significant difference maintained until final follow-up. Over time, CL, SVA, and T1S tended to return to their preoperative states regardless of screw type. Two patients who underwent LMS fixation, but none who underwent CPS fixation, required unplanned or additional anterior fusion surgery for revision. The present study is the first radiologic comparison of LMS and CPS fixation after posterior-only fusion surgery. CPS resulted in more reliable and well-preserved SA correction,