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Research ArticleLumbar Spine

Can L5 Be Trusted During Proximal Extension of Fusion From Prior L4–L5 Fusion to T10–Vertebral Body Fracture After T10–L5 Revision Fusion? A Case Series and Review of the Literature

David Cheng, Michael Hall, Bryan Penalosa, Olumide Danisa and WAYNE CHENG
International Journal of Spine Surgery June 2020, 7043; DOI: https://doi.org/10.14444/7043
David Cheng
1University of Southern California, California, Los Angeles, California
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Michael Hall
2University of Riverside, Riverside, California
MS
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Bryan Penalosa
3Loma Linda University, Loma Linda, California
MD
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Olumide Danisa
3Loma Linda University, Loma Linda, California
MD
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WAYNE CHENG
4Veterans Health Administration, Loma Linda, California
MD
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ABSTRACT

Background Debate on whether to stop fusion at L5 or to extend fusion to S1 in a long spinal construct has been a controversial topic in spine surgery. Fewer data are available to support whether to include a prior solid fusion at L4–L5 or to extend to S1 during a proximal extension of fusion to T10. The purpose of this review is to report and discuss 2 cases of L5 vertebra fracture after proximal extension of solid L4–L5 fusion to T10 and to provide a guideline to surgeons based on the available literature.

Methods Case report and literature review.

Results Literature review identified multiple publications with levels of evidence from level 2 to level 4. Advanced L5–S1 degeneration with long-segment fusion to L5 is reported to be greater than 60% with a new rate of symptom development approaching 20%–25%. There is no prior literature specific to L5 fracture development after thoracic lumbar fusion with the lowest instrumented level at a fused L4–L5 segment. Reoperation rate is not consistently affected by the lowest instrumented vertebral level L5 versus sacrum/ilium.

Conclusions Literature review is inconclusive as to the need to include the lumbosacral junction when performing a proximal extension of fusion from L5 to the thoracic spine, especially during a revision adult deformity surgery. Stress of the long lever arm of a long-segment thoracolumbar fusion above a prior solid L4–L5 fusion could cause the L5 vertebra to split in the coronal plane, resulting in vertebral body fracture even with a mildly degenerated disc at L5–S1 prior to surgery.

Level of Evidence 4.

  • L5 vertebral body fracture
  • T10–L5 fusion
  • T10–S1 fusion
  • coronal plane fracture

Footnotes

  • Disclosures and COI: Dr Danisa reports personal fees from Spineart and from Globus Medical outside the submitted work. Dr Cheng reports fees from Medtronic and from DePuy/Johnson & Johnson outside the submitted work.

  • ©International Society for the Advancement of Spine Surgery
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Can L5 Be Trusted During Proximal Extension of Fusion From Prior L4–L5 Fusion to T10–Vertebral Body Fracture After T10–L5 Revision Fusion? A Case Series and Review of the Literature
David Cheng, Michael Hall, Bryan Penalosa, Olumide Danisa, WAYNE CHENG
International Journal of Spine Surgery Jun 2020, 7043; DOI: 10.14444/7043

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Can L5 Be Trusted During Proximal Extension of Fusion From Prior L4–L5 Fusion to T10–Vertebral Body Fracture After T10–L5 Revision Fusion? A Case Series and Review of the Literature
David Cheng, Michael Hall, Bryan Penalosa, Olumide Danisa, WAYNE CHENG
International Journal of Spine Surgery Jun 2020, 7043; DOI: 10.14444/7043
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  • Comparison of Stand-Alone Anterior Lumbar Interbody Fusion, 360° Anterior Lumbar Interbody Fusion, and Arthroplasty for Recurrent Lumbar Disc Herniation: Focus on Nerve Decompression and Painful Spinal Instability Resolution
  • Recovery Trajectories After Lumbar Fusion Stratified by Baseline Patient-Reported Outcomes Measurement Information System Physical Function Disability Levels
  • Association Between Nonsteroidal Anti-inflammatory Drugs Use and Surgical Outcomes Following Posterior Lumbar Fusion: A Medical Claims Database Analysis
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Keywords

  • L5 vertebral body fracture
  • T10–L5 fusion
  • T10–S1 fusion
  • coronal plane fracture

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