SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2020
Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis.
Synthesis in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05566119 (L5-S1 Disc Fate in Thoracolumbar Arthrodesis Stopping at L5), which is not on this map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
L5-S1 Disc Fate in Thoracolumbar Arthrodesis Stopping at L5
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- L5 vs. pelvic fixation as the lowest instrumented vertebra in long-segment fusion for adult spinal deformity: a systematic review and meta-analysis.Spine deformity · 2026Pooled it
- Factors associated with favorable outcomes of floating fusion or lumbosacral spinal fusion in adult spinal deformity surgery: an analysis of the incidence of mechanical complications from a multicenter study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- L5 Is a Reliable Lower Instrumented Vertebra in Selected Adult Spinal Deformity Patients.Global spine journal · 2026Article
- A fast classification system for adult spinal deformity with sagittal imbalance based on spinal sagittal parameters.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Junctional Failures Following Long-Level Fusion to L5 in Elderly Patients: Impact of Spinopelvic Alignment and L5-S1 Disc Degeneration.Medicina (Kaunas, Lithuania) · 2026Article
- Indications of Clinical Application of L5 Laminar Hook for the Surgical Correction of Degenerative Sagittal Imbalance.Medicina (Kaunas, Lithuania) · 2025Article
- Does spinopelvic imbalance after minimally invasive lower lumbar fusion predispose patients to subsequent minimally invasive sacroiliac joint fusions? a case-control study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Segmental Interbody, Muscle-Preserving, Ligamentotaxis-Enabled Reduction: "SIMPLER" Technique for cMIS Correction of ASD.International journal of spine surgery · 2025Article
- Article
- Sagittal alignment of diverse mechanical complications following adult spinal deformity surgery.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2024Article
- Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity: Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up.Global spine journal · 2023Article
- Demineralized cortical fibers are associated with a low pseudarthrosis rate in patients undergoing surgery for adult spinal deformity without three-column osteotomy.Brain & spine · 2023Article
- Factors and predictive model associated with perioperative complications after long fusion in the treatment of adult non-degenerative scoliosis.BMC musculoskeletal disorders · 2021Article
- Can fusion to S1 maintain favorable surgical outcomes following one-level pedicle subtraction osteotomy in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis?European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2020Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeChoosing an optimal distal fusion level for adult spinal deformity (ASD) is still controversial. To compare the radiographic and clinical outcomes of distal fusion to L5 versus the sacrum in ASD, we conducted a meta-analysis.
methodsRelevant studies on long fusion terminating at L5 or the sacrum in ASD were retrieved from the PubMed, Embase, Cochrane, and Google Scholar databases. Then, studies were manually selected for inclusion based on predefined criteria. The meta-analysis was performed by RevMan 5.3.
resultsEleven retrospective studies with 1211 patients were included in meta-analysis. No significant difference was found in overall complication rate (95% CI 0.60 to 1.30) and revision rate (95% CI 0.59 to 1.99) between fusion to L5 group (L group) and fusion to the sacrum group (S group). Significant lower rate of pseudarthrosis and implant-related complications (95% CI 0.29 to 0.64) as well as proximal adjacent segment disease (95% CI 0.35 to 0.92) was found in L group. Patients in S group obtained a better correction of lumbar lordosis (95% CI - 7.85 to - 0.38) and less loss of sagittal balance (95% CI - 1.80 to - 0.50).
conclusionOur meta-analysis suggested that long fusion terminating at L5 or the sacrum was similar in scoliosis correction, overall complication rate, revision rate, and improvement in pain and disability. However, fusion to L5 had advantages in lower rate of pseudarthrosis, implant-related complications, and proximal adjacent segment disease, while fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance, and absence of distal adjacent segment disease. These slides can be retrieved under Electronic Supplementary Material.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.