Tarık ELMA, Mustafa ÇELİKTAŞ, Mehmet ALTUĞ, Mahir GÜLŞEN
Journal of Turkish Spinal Surgery - 2026;37(1):42-49
Objective: In this retrospective analysis, we evaluated differences in clinical and radiological outcomes between elderly patients with degenerative spinal deformity whose extended posterior spinal fusion terminated at L5 and those whose fusion extended to S1/S2. Materials and Methods: We retrospectively reviewed the medical records of 113 patients aged 60 years and older who underwent long posterior spinal fusion for degenerative spinal disease and had a minimum follow-up of two years. According to the caudal extent of fusion, patients were categorized into two groups: those in whom fusion terminated at L5 (lumbar group, n=39) and those in whom fusion extended to S1 or S2 (sacral group, n=74). Pain levels and functional status were evaluated using the visual analog scale and the Oswestry disability index (ODI), respectively. Results: Patients in both groups showed notable improvements in back pain, leg pain, and ODI scores following surgery. Both groups showed a significant increase in lumbar lordosis, with higher postoperative values in the lumbar group (p=0.005). Thoracic kyphosis did not change significantly in either group; however, the direction and magnitude of change differed between groups (p=0.041). Overall complication and reoperation rates were similar between groups. Distal adjacent segment disease was observed in four patients (10.26%) in the lumbar group, whereas none were detected in the sacral group (p=0.013). Conclusion: Long posterior spinal fusion terminating at either L5 or the sacrum provides comparable postoperative pain relief and radiographic outcomes. Sacral distal fusion is associated with greater functional improvement, while lumbar distal fusion carries a higher risk of distal adjacent segment disease. Distal fusion level selection should therefore be individualized based on patient-specific clinical and radiological characteristics.
