Fast Five Quiz: Spine Pain

Herbert S. Diamond, MD


May 16, 2019

Selection of the fusion level is important in the surgical treatment of kyphosis. The proximal level is usually the most cranial vertebra rotated into the kyphosis. In the distal aspect, the fusion is commonly extended to the last lordotic segment; however, some have advocated using the sagittal stable vertebra to determine the distal fusion level. Recommended correction should not exceed 50%. Overcorrection of the deformity (> 50%) and inadequate selection of fusion levels can predispose a patient to junctional kyphosis at the proximal and distal extent of the fusion mass.

Authors from early clinical series simply cited pain and deformity as reasons to perform fusion. Proposed indications more specific than these are kyphosis greater than 75°, kyphosis greater than 65° with pain, and an unacceptable appearance of the trunk.

Surgical intervention for posttraumatic kyphosis is recommended if the patient's neurologic status changes, if the condition progresses, if the kyphosis is 30° or more, or if the loss of anterior vertebral height is more than 50%. 

Read more about the treatment of kyphosis.


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