title: Multi level lumbosacral spinal fusion including lumbo-Sacral (L5-S1) junction fixation in adult deformity surgery; is postero- lateral fusion at (L5-S1) alone adequate?
abstract: OBJECTIVE
  To assess the revision rate at L5-S1 when only posterior fixation with pedicle screws is done with multi-level spinal fixation.
  
  
  METHODS
  The Retrospective quasi experimental study was conducted at the Combined Military Hospital, Rawalpinidi and comprised data from 2009 to 2014 of patients in whom multi-level posterior decompression including lumbosacral junction (L5-S1) with laminectomy and posterior fixation with pedicle screws was done till L3 and higher. Those with known cause of implant failure like osteoporosis, osteomalacia and infection were excluded. Patients were followed up and need for revision at L5-S1 level was assessed.
  
  
  RESULTS
  Of the 22 cases, 5(23%) were males and 17(77%) were females with an overall mean age of 64±10.38 years (range 48-84 years). Mean number of levels fixed was 5.22±1.15 the highest level of fixation being T11. Mean follow-up was 08±3.22 months and focused only at the failure of fixation at L5-S1. Two (9%) cases showed implant loosening and required revision at L5-S1 because of screw cut out.
  
  
  CONCLUSIONS
  Properly placed pedicle screws were adequate with fusion for multilevel spinal fixations.
authors.affiliation: Combined Military Hospital, Rawalpindi.
authors.forename: Ahmed Bilal
authors.initials: AB
authors.lastname: Khalique
authors.affiliation: Combined Military Hospital, Rawalpindi.
authors.forename: Ibrahim Farooq
authors.initials: IF
authors.lastname: Pasha
authors.affiliation: Combined Military Hospital, Rawalpindi.
authors.forename: Akmal
authors.initials: A
authors.lastname: Sultan
authors.affiliation: Combined Military Hospital, Rawalpindi.
authors.forename: Waseem
authors.initials: W
authors.lastname: Afzal
authors.affiliation: Combined Military Hospital, Rawalpindi.
authors.forename: Muhammad Asad
authors.initials: MA
authors.lastname: Qureshi
keywords: Lumbosacral junction, Posterior fixation, Pedicle screws, Spinal fixations.