Review Question - QID 219629

A 15-year-old otherwise healthy female presents with progressive scoliosis. She has an apex-right thoracic curve measuring 55° that corrects to 25° on side bending, and an apex-left lumbar curve measuring 30° that corrects to 10°. On the lateral view radiograph, you note a thoracolumbar kyphotic deformity involving the T8-L2 levels, with 70% of the L2 vertebral body resting posterior to the posterior sacral vertebral line (PSVL), and 40% of the L3 vertebral body resting posterior to the PSVL. The posteroanterior (PA) radiograph additionally reveals that the L4 vertebrae is tilted to the right. To reduce the risk of distal junctional kyphosis (DJK) and need for revision to extend the fusion, which of the following is the most appropriate lowest instrumented vertebra (LIV) level?