Controversy. Fusion of L5-S1 in adult scoliosis.

Correction of adult scoliotic deformities often involves long segment fusions into the lower lumber spine. The risks of late complications from excluding L5-S1 from the fusion include subsequent lumbosacral instability and pain and must be weighed against the additional risks and complications of routinely including L5-S1 in these long fusions. Dr. Holt and his colleague are emphatic that fusion of L5-S1 should be avoided at all costs; Dr. Horton believes that long-term follow-up results suggest the benefits of including this level may outweigh the added risks and offers a more tempered opinion.