Improvements in #spinesurgery and in fact all #surgery are often incremental. If we are progressive as surgeons we identify problems we see in diagnosis, planning, in the OR and most importantly in follow-up.

Sometimes we see a high volume of patients with post surgery issues but as we don’t know the “denominator” it can be hard to work out the truth. Particularly in a complex spine practice where patients with issues from prior surgery often seek care.

There has been a lot of debate about fusions deep into the lumbar spine for #scoliosis. Is it better than the natural history? Long term data suggest that it may not be….

If that is the case we need to look at alternatives. These are based on sound principles of growth modulation and remodelling that are established in #orthopedicsurgery – the Hueter Volkmann principle and Wollf’s law.

Spine fusion is a great option for many patients. But we need to limit the extent of spinal immobilization. If that means some patients (still a minority) need further procedures then that is part of informed consent.

I believe those of use who know what we are doing have reached “peak-fusion”. I don’t see it getting much better – even with incremental improvements. So let’s do better.

Below is a patient advised fusion to L4. I was able to stop at L2. So far so good…

But if we had to go lower = see pic no. 2 for a hybrid procedure…