ArticleFrontiers in surgery2026
Is extension of multi-level lumbar fusion to S1 necessary in the absence of L5-S1 instability? A comparative study of selective decompression versus TLIF with S1 pedicle screw fixation.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: S1 pedicle screw loosening remains a clinically significant complication in lumbosacral fusion, with reported incidences ranging from 15.6% to 41.9%. In patients undergoing multi-level posterior lumbar fusion with concomitant symptomatic but stable L5-S1 pathology, it remains unclear whether extending the construct to the sacrum is necessary. Methods: This retrospective study included 60 patients who underwent multi-level posterior lumbar instrumentation (fusion constructs spanning 2-4 segments) between November 2023 and April 2024. All patients had symptomatic L5-S1 pathology (disc herniation or stenosis) without radiographic instability, and required fusion for upper lumbar pathology. Patients with L5-S1 instability (>3 mm translation or >10° angulation on flexion-extension radiographs) were excluded. Group 1 ( Results: Groups were comparable at baseline. Operative time (148.4 ± 26.1 vs. 204.7 ± 32.8 min, Conclusion: In this retrospective cohort, selective decompression of the L5-S1 segment without S1 instrumentation was associated with comparable mid-term clinical outcomes while reducing operative time, blood loss, and S1 screw-related complications.
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