Distal instrumented level selection in adult deformity surgery

Abstract

Adult spinal deformity surgery has many aspects that need to be considered prior to and during surgery for the best long-term outcome. Determining where to place the lower instrumented level in the fusion construct can be a difficult decision. There are multiple factors that need to be taken into account including the individual patient's anatomy, the mechanical concept of a fusion mass, surgical techniques, and junctional levels particularly the L5-S1 level when determining where to end a fusion. Understanding these concepts will decrease the risk of complications at this level post-operatively.