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            [0] => Does a leveled lowest  instrumented Vertebra(LIV) lead to better outcomes when ending L3 or L4
        )

    [etablissement] => Array
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            [0] => hopital d'enfants de tunis
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    [nom] => Array
        (
            [0] => aouinti
        )

    [prenom] => Array
        (
            [0] => mohamed nizar
        )

    [email] => Array
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            [0] => aouintinizar4@gmail.com
        )

    [telephone] => Array
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            [0] => 58918474
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            [0] => 
 
Nom prénom / Name Surname: aouinti mohamed nizar
Email: aouintinizar4@gmail.com
Hôpital / Hospital: hopital d'enfants de tunis

 
Nom prénom / Name Surname: MOHSENI ahmed
Email: ahmedaminemohsni@hotmail.com
Hôpital / Hospital: 

 
Nom prénom / Name Surname: Tebai achref
Email: 
Hôpital / Hospital: 

 
Nom prénom / Name Surname: rim boussetta
Email: 
Hôpital / Hospital: 

 
Nom prénom / Name Surname: mohamed nebil nessib
Email: 
Hôpital / Hospital: 

 
Nom prénom / Name Surname: zairi mohamed
Email: 
Hôpital / Hospital: 

        )

    [mots_cles] => Array
        (
            [0] => lowest  instrumented Vertebra;

        )

    [event-id] => Array
        (
            [0] => 3663
        )

    [statut] => Array
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            [0] => 1
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    [forme] => Array
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            [0] => none
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    [user_email] => Array
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            [0] => aouintinizar4@gmail.com
        )

    [specialite] => Array
        (
            [0] => Chirurgie orthopédique et traumatologique
        )

    [pays] => Array
        (
            [0] => Tunisie
        )

    [texte_abs] => Array
        (
            [0] => Extension of fusion distally to L4 remains  reported in the literature  to a less outcomes Fusing to L4  is associated with leveling of the LIV results with long-term disk degeneration under the fusion. Thus, the decision to include L4 remains difficult. There may be unrecognized benefits of extending the fusion distally to include L4. 
The objective of this project was to determine if leveling the LIV independent of the level fused played a role in midterm outcomes (5 years post-op). 
Methods 
All patients of all curve types with a fusion either to L3 or L4 with pre-op and 5-year post-operative visits were included. We evaluated the score with  SRS-22 r  pain score. Chi-square and CART analysis were performed to determine if leveling the distal fusion level to a tilt <5° would result in an improvement for SRS 22pain score.
Results
 We collected  128 patients. When leveling of the LIV showed greater rate of improvement for both . CART showed that for Pain, leveling the LIV was more impactful than extent of fusion with a 63% rate of improvement compared to 44% when not leveled. When LIV tilt was <5% patients with a fusion to L4 did not improve as much 41% as patients fised to L3 46%.
Discussion:
Surgeons try to avoid extending the fusion down to L4 based on the risk of disk degeneration under the fusion. In our cohort overall levelling the LIV <5° resulted in greater improvement in SRS 22R pain score.
Conclusion:
Extension of fusion distally to L4 remains  reported in the literature
        )

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