The lumbosacral junction is the transition zone between the mobile lumbar spine and the rigid sacrum, making it the highest-stress segment in the lumbar spine. The lumbosacral angle and degree of sacral slope significantly affect L5-S1 disc stress. Isthmic spondylolisthesis exclusively affects this level, and L5-S1 fusion rates are higher than any other lumbar level.
L5-S1 posterior spinal fusion is the most performed single-level lumbar fusion — for spondylolisthesis, disc disease, and degenerative instability. The iliolumbar ligament from L5 transverse process to the iliac crest provides natural restraint against listhesis and must be removed for adequate surgical exposure at L5-S1.
Bilateral pars defect allowing forward L5 slip on S1 producing buttock and radicular pain managed with decompression and fusion at this level.
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