Extension to the sacrum of previous adolescent scoliosis fusions in adult life.

Numerous reports have indicated an increased risk for the development of precocious degenerative changes leading to pain in patients who had fusions done in adolescence for scoliosis, which extended into the lower lumbar spine. The anatomic situation may lead to instability, or spinal stenosis or both. This paper represents the evolving experience in reconstructive surgery for patients in whom a fusion was to be extended to the sacrum. Reconstructive surgery will require, if necessary, decompression posteriorly for spinal stenosis if present. Stabilization is acquired through an anterior and posterior approach with anterior and posterior instrumentation. The evolution of treatment modalities since 1976 shows a decreased pseudarthrosis rate from an initial 83% to 3% at present.