Is using ALIF at the distal levels of long spinal deformity 

Is using ALIF at the distal levels of long spinal deformity constructs associated with significantly reduced incidence of distal mechanical complications and pseudoarthrosis in comparison to PLIF?

Is using ALIF at the distal levels of long spinal deformity

Very poor, out of focus, more like history than introduction to the problem this manuscript is dealing with.

It should be concise, describing what is known about this problem and what is unknown that made you think of doing this research.

Don’t talk about the history
Research Question must be clear formulated
Less than 1 page

Aim of work: clear

A bit disorganized and lacks some important information. Must mention that we obtained an ethical review board approval and its relevant number.

The writing language is also not good enough for the European Spine Journal and needs a lot of editing.
Type of cage (4 Web titanium Cage) and its criteria that may serve to better results e.g.  Good biomechanics, good lordships, titanium material of cage, big footprints:

You mentioned both PLIF and TLIF. In the methods section, you did not provide detailed information about the surgical technique used. It was modified PLIF (with 2 cages inserted bilaterally and with bilateral facetectomy i.e. with removal facet joints.

Additionally, you mentioned no details about doing the ALIFs. Must mention it was minimally invasive ALIF with usage of Synframe special retractor. Must mention that the posterior surgery was done first and then patient was rotate  and ALIF done. In some cases these werde done at same surgical settings. In other cases this was done in 2nd separate surgical setting.  How many average days in between? Who decided on doing PLIF or ALIF? Must mention it was according to According to surgeon preference and experience.


How long was the follow up duration? At least 24 Months (minimum / maximum / mean). You mentioned nothing about this. You must mention that u excluded patients less than 2 years follow up and those who died ie 3 cases and those with incomplete xrays /CT.

Agwad etal and Lenke paper read very well. Because this is the most relevant to us. But they have differrent results. Our argument for our different result should be a different and therefore better type of ALIF Cage ie 4 WEB cage

Discussion is very poor.
If you believe and your results support the use of ALIF instead of PLIF, you should bring every argument and document from the literature to support your results. You cannot also ignore that a quite similar but significantly larger series (Adogwa et al, 2019) had a contradictory conclusion; “There were no differences between groups in the prevalence of rod fracture or revision surgery,
However, and both groups had low bilateral rod fracture prevalence and incidence rates. One technique is not clearly superior to the other.” You have to explain, at least theoretically, what you reached a different conclusion.

Limitations of the study:

We must mention the Following
1. Number of cases small.
2.It is retrospective study however it is enough good as we are not assessing scores was a must due to follow up of complication and radiological evidences and mechanical complication.
3. You have to recognize and report honestly on the limitations of this study. Also, you have to make it clear to the reader, what new information this work is adding to the available body of knowledge and what distinguishes your work from the others. Unless the journal and the reviewers are convince that you are providing new information, they will just congratulate you for your work but reject to publish because of the lack of new information.

Conclusion (especially that in the abstract)
It has to be rewritten. It should be concise, focused on the conclusion you draw from your work, not from the literature.