In 850 consecutive patients with idiopathic scoliosis, no primary lumbosacral curve with only secondary curves above it was found. Forty-four patients with double structural thoracic and lumbar, single structural thoracic, and single structural lumbar curves showed progressive loss of flexibility in the lumbosacral area. Of these, five patients had correction and fusion of the lumbosacral curve and seventeen had correction and fusion of the major curve above the third or fourth lumbar segment without surgical treatment of the lumbosacral area. The results were better in the latter group. Correction and fusion in the lumbosacral area was difficult to achieve. No patient had a permanent list when only curves above the lumbosacral curve were corrected and fused. Lumbosacral fusion should be reserved for primary lumbosacral curves associated with congenital anomalies or spondylolisthesis.
Copyright 1980 by The Journal of Bone and Joint Surgery, Incorporated