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The Fate of L5–S1 with Low Dose BMP-2 and Pelvic Fixation in Adult Deformity Surgery

Pseudarthrosis at L5–S1 is one of the most common complications of long fusions to the sacrum in adult deformity surgery. Strategies for decreasing pseudarthrosis include interbody fusion, use of BMP-2 at the lumbosacral junction, and the use of sacropelvic fixation, individually or in combination. High-dose BMP-2 (20–40 mg) placed posterolaterally has shown comparable fusion rates to interbody fusion. The purpose of this study was to evaluate L5–S1 fusion rates when lower dose BMP-2 (average 3.2 mg) and pelvic fixation were used, with or without interbody fusion.