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Retrospective observational cohort study.We used observational measures and retrospective chart reviews to compare elderly patients with osteoporosis who underwent multi-level anterior lumbar interbody fusion (ALIF) with either posterolateral fusion (PLF) or percutaneous pedicle screw fixation.Multi-level ALIF with PLF is used to save the posterior element of the spine and improve fusion rates in elderly patients with osteoporosis. To minimize perioperative invasiveness and improve patients' postoperative quality of life, we perform minim