The pros and cons to saving the L5-S1 motion segment in a long scoliosis fusion construct

Study Design. This is a review of the literature and personal experience as it pertains to whether a long fusion should be stopped at L5 or S1 in a patient with adult lumbar scoliosis and degenerative changes. Objectives. To summarize the problems with decision-making and to point out the strengths and limitations of past studies. Summary of Background Data. There is a paucity of data on this subject. Problems with stopping at L5 include fixation at that segment and subsequent breakdown at L5-S1. The problems with stopping at the sacrum include the additional surgical requirements and increased potential for pseudarthrosis. Methods. Summarized is past literature and, to some extent, personal experience of the author(s). Results. There are situations where it is clearly preferable to stop at the sacrum. However, there are many borderline-circumstances in which whether it is better to stop at L5 or the sacrum is not clear cut. Conclusions. The answer to this question requires further study. Multicenter data collection, consistency of approach, and potential randomization in a prospective fashion might help provide an answer.