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.