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Related Concept Videos

Vertebral Column: Regions and Curvature01:16

Vertebral Column: Regions and Curvature

The vertebral column or spine is a flexible column that supports the head, neck, and body and  allows for their movements. It also protects the spinal cord.
Regions of the Vertebral Column
In an adult, the spine is subdivided into five regions: the cervical, the thoracic, the lumbar, the sacral, and the coccygeal region. The spine initially develops as a series of 33 vertebrae; after 20 years of age, the nine bones in the sacral region, five sacral, and four coccygeal bones fuse to form the...

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Related Experiment Video

Updated: Jun 30, 2026

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position
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L5 Is a Reliable Lower Instrumented Vertebra in Selected Adult Spinal Deformity Patients.

Susana Núñez-Pereira1,2, Sleiman Haddad1,2, Lluís Vila1,2

  • 1Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain.

Global Spine Journal
|June 29, 2026
PubMed
Summary

In adult spinal deformity surgery, stopping fusion at L5 is safe for well-aligned patients. Poor sagittal alignment post-surgery significantly increases the risk of distal junctional failure, necessitating pelvic extension.

Keywords:
Pelvispatient reported outcome measurementsrisk factorssacrumspinal fusion

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Last Updated: Jun 30, 2026

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position
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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability

Published on: July 25, 2025

Area of Science:

  • Orthopedics
  • Spine Surgery
  • Adult Spinal Deformity

Background:

  • Sacropelvic fusion in adult spinal deformity (ASD) surgery enhances stability but increases morbidity.
  • Stopping fusion at the L5 vertebra preserves motion but risks distal junctional failure (DJF).
  • Identifying DJF risk factors in L5-instrumented ASD patients is crucial for surgical planning.

Purpose of the Study:

  • To identify risk factors for distal junctional failure (DJF) in adult spinal deformity (ASD) patients undergoing posterior fusion with the lowest instrumented vertebra (LIV) at L5.
  • To evaluate the safety and outcomes of stopping fusion at L5 versus extending to the sacropelvis.

Main Methods:

  • Retrospective analysis of a multicenter prospective adult spinal deformity (ASD) database.
  • Inclusion criteria: posterior fusion with LIV at L5 and minimum two-year follow-up.
  • Analysis included demographic data, radiographic parameters, and patient-reported outcomes; survival analysis and multivariate regression identified predictors of DJF and malalignment.

Main Results:

  • Fifteen of 81 patients (18.5%) required pelvic extension (EP) due to DJF.
  • Preoperative malalignment (higher sagittal vertical axis [SVA] and global tilt) was more common in the EP group.
  • Postoperative SVA >45 mm strongly predicted DJF, with 5-year DJF-free survival of 48.6% vs. 95.1% in well-aligned patients (p<0.001).

Conclusions:

  • Fusion to L5 is a safe option for well-aligned adult spinal deformity patients, with ~80% avoiding pelvic extension at five years.
  • Inadequate postoperative sagittal correction is a significant risk factor for distal junctional failure (DJF).
  • Older patients with preoperative malalignment may benefit from primary sacropelvic fusion to prevent DJF.