PURPOSE: This report compares the clinical, radiographic, and functional outcomes of fusion from thoracolumbar region terminating at L5 or at sacrum and pelvis in elderly patients with spinal deformity.

METHODS: Ninety-four elderly patients who underwent spinal deformity surgery at our institution were evaluated. Patients were divided into two groups. The group L included 43 patients who underwent fusion of lumbar curve from thoracolumbar region to L5. The group P consisted of 51 patients who were treated using fusion from lower thoracic region to S1 extending to the pelvis. Radiographic outcomes, health-related to the quality of life (HRQOL) parameters, and complications with a 3-year minimum follow-up were analyzed and compared between two groups.

RESULTS: In the group L, the ideal sagittal balance was not achieved. The group P showed a better restoration of global spinal alignments compared with the group L. The HRQOL scores (VAS, ODI, SRS-24) of the patients after 3 years are slightly higher in the group P, but we did not get significant difference between groups. The total number of complications was higher in the group P.

CONCLUSIONS: The research showed that fusion of lumbar curve extending to the pelvis provided good sagittal balance, global spinal alignments, and likely HRQOL parameters after 3-year follow-up. But, eventually, we obtained higher number of complications.