Purpose: To document clinical and radiographic outcome, and survivorship of long fusion constructs (> T12) stopping at L5.

Methods: Retrospective clinical and radiographic analysis of long fusions to L5 in an adult population, with follow-up greater than 5 years.

Results: We reviewed a consecutive series of patients with long fusion constructs ending at L5 from 1991–2000. 33 patients were identified with fusions from the thoracic spine to L5. 14 patients were excluded, including 7 deaths, 3 patients lost to follow-up, and 4 patients with incomplete radiographic and clinical data sets. There were 17 females and 2 males, with average age of 50 (range 25–73). 7 patients have since undergone extension of fusion to the sacrum, and comprised Group II; the remaining 13 patients comprised Group I. There was no association between preoperative radiographic characteristics of the deformity and outcome (coronal/ sagittal plane imbalance, curve magnitude). Specifically, the lumbosacral disk space appearance (disk height, lordosis) was similar in both groups preoperatively. Presence of postop degenerative changes at the lumbosacral disk did not correlate with outcome. Patients in group I and II had similar scores in SRS, ODI and SF-12 outcome measures. Some patients reported a change in functional status after revision to sacrum, including change in gait pattern, loss of twisting and bending ability, and more difficulty with perineal care. At least 4 patients in Group I are being considered for revision.

Conclusions: In conclusion, long fusions to L5 in an adult deformity population yields unpredictable results more than 5 years after surgery. Although of smaller magnitude than primary fusions to sacrum, stopping at L5 is associated with a significant revision rate. Some patients with long fusions to L5 have good function more than 5 years after surgery.