Spine
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When a patient presents with spine problems, the spine surgeon would do well to avoid use of, reliance on, and acceptance of radiographs as the sole or primary source of information. Measurement of pelvic incidence and lumbar lordosis, although crucial, does not take into account the effort the patient must make to move, the level of involvement of other parts of the body, and the history of previous procedures and outcomes. Radiographs may show pathology that is not consistent with the appearance of the patient. How should we assess this situation?
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In treating patients with idiopathic scoliosis and Lenke 1C curves, surgeons must choose between selective fusion of the thoracic spine (STF) and nonselective fusion of the thoracic and lumbar spines. Research shows mixed results. Demura et al reported that 40% of patients who had undergone selective fusion of the thoracic curve were decompensated 2 cm after 2 years, and 89% of those treated with nonselective fusion were balanced in the thoracic and lumbar planes, regardless of preoperative balance.