E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Impact Of Sacral Instrumentation On Lumbar Fusion Outcomes: A Ten-Year Comparative Analysis With Cases Instrumented To L5
OKTAY ELTER✉ ,
KEREM YILMAZ ,
ORHAN GÜNAY ,
CELAL KARAKIŞLA ,
UMUT OGÜN MUTLUCAN ,
CEZMİ ÇAĞRI TÜRK
KEREM YILMAZ ,
ORHAN GÜNAY ,
CELAL KARAKIŞLA ,
UMUT OGÜN MUTLUCAN ,
CEZMİ ÇAĞRI TÜRK
Neurosurgery, Antalya Training and Research Hospital; Neurosurgery, University of Health Sciences
DOI: 10.5137/1019-5149.JTN.50849-26.2
Accepted: 24/05/2026
Article in Press
Corresponding Author:
OKTAY ELTER (oktayelter@gmail.com)
Abstract
Aim
To evaluate the contribution of the sacrum to stability in lumbosacral stabilization surgeries and effect on revisions. The limited comparative data between stabilization at L5 and extension to S1 provided the rationale for this study.
Material and Methods
Between January 2010 and 2021, all patients who underwent posterior spinal instrumentation at a single tertiary center were retrospectively reviewed. Patients over 18 years with L5S1 pathologies who underwent stabilization, excluding tumors or vascular malformations, were included. Exclusion criteria were procedures not ending at L5 or the sacrum, and cases with insufficient clinical data. Data included demographics, surgical techniques, preoperative and postoperative spinopelvic parameters, fusion status, and reoperation rates.
Results
Of 2,955 patients, 1,297 met inclusion criterias. Mean age was 59.1 ± 11.7 years, 68.5% were female. The most common indications were lumbar stenosis and other degenerative causes (60.2%), and spondylolisthesis (29.4%). Interbody fusion was performed in 49.7% and was significantly more frequent when the terminal vertebra was L5 (p ≤ 0.004). Autologous bone grafts were used more often than cages for interbody fusion. Preoperative pelvic tilt and incidence were higher in the L5 group (p < 0.001), while postoperative parameters showed no significant differences (p > 0.05). At six months, fusion rates were similar (p ≥ 0.154), though early fusion was higher in cases with interbody fusion (p < 0.001). Reoperation was required in 5.9% of patients, significantly more in the S1 group (p ≥ 0.043). Revision surgery was more frequent in non-fusion cases (p < 0.001).
Conclusion
This study compared posterior lumbar stabilization ending at L5 with extension to S1. Postoperative alignment and fusion rates were similar between groups. However, reoperation rates were higher in cases extended to S1. These findings suggest that, in selected patients, ending at L5 may provide comparable outcomes with a lower complication risk. Therefore, the distal fixation level should be individualized.
To evaluate the contribution of the sacrum to stability in lumbosacral stabilization surgeries and effect on revisions. The limited comparative data between stabilization at L5 and extension to S1 provided the rationale for this study.
Material and Methods
Between January 2010 and 2021, all patients who underwent posterior spinal instrumentation at a single tertiary center were retrospectively reviewed. Patients over 18 years with L5S1 pathologies who underwent stabilization, excluding tumors or vascular malformations, were included. Exclusion criteria were procedures not ending at L5 or the sacrum, and cases with insufficient clinical data. Data included demographics, surgical techniques, preoperative and postoperative spinopelvic parameters, fusion status, and reoperation rates.
Results
Of 2,955 patients, 1,297 met inclusion criterias. Mean age was 59.1 ± 11.7 years, 68.5% were female. The most common indications were lumbar stenosis and other degenerative causes (60.2%), and spondylolisthesis (29.4%). Interbody fusion was performed in 49.7% and was significantly more frequent when the terminal vertebra was L5 (p ≤ 0.004). Autologous bone grafts were used more often than cages for interbody fusion. Preoperative pelvic tilt and incidence were higher in the L5 group (p < 0.001), while postoperative parameters showed no significant differences (p > 0.05). At six months, fusion rates were similar (p ≥ 0.154), though early fusion was higher in cases with interbody fusion (p < 0.001). Reoperation was required in 5.9% of patients, significantly more in the S1 group (p ≥ 0.043). Revision surgery was more frequent in non-fusion cases (p < 0.001).
Conclusion
This study compared posterior lumbar stabilization ending at L5 with extension to S1. Postoperative alignment and fusion rates were similar between groups. However, reoperation rates were higher in cases extended to S1. These findings suggest that, in selected patients, ending at L5 may provide comparable outcomes with a lower complication risk. Therefore, the distal fixation level should be individualized.
Keywords
Lumbar Vertebrae
Spinal Fusion
Spinal Instrumentation
Lumbosacral Region
Reoperation