title: Long-segment fusion of the thoracolumbar spine in conjunction with a motion-preserving artificial disc replacement: case report and review of the literature.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  We reviewed the case of a 44-year-old woman who underwent long-segment fusion and an artificial disc replacement.
  
  
  BACKGROUND
  There have been many reported advantages and disadvantages of stopping the fusion at L5, with the theoretical benefits being preserved motion, shorter operative time, allowing the remaining disc to compensate for curve correction cephalad in the lumbar spine, and a decreased likelihood for the development of a pseudarthrosis at that distal level.
  
  
  METHODS
  As the issue of the fate of the L5-S1 motion segment continues to be debated, we present the case of a medium-segment thoracolumbar fusion carried down to the L4 stable vertebra, an intervening healthy L4-L5 disc space, with the placement of an artificial disc arthroplasty at the L5-S1 level for a degenerative and discographically positive pain generator.
  
  
  RESULTS
  At 2-year follow-up, her L5-S1 artificial disc replacement level shows 11 degrees range of motion and consolidated fusion from T12 to L4 with complete resolution of her axial back pain. Her T12-L4 construct is stable, and the L4-L5 level is unaffected at the latest follow-up. Her clinical outcome has been excellent with her return to a very active lifestyle.
  
  
  CONCLUSIONS
  Artificial disc replacement below a long-segment fusion is a viable alternative to performing fusion to additional motion segments.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Walter Reed Army Medical Center, Washington, DC, USA.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Lehman
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D018786:Bone Substitutes; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D019736:Prostheses and Implants; D016059:Range of Motion, Articular; D012600:Scoliosis; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D018786:Bone Substitutes