Linda, that was eye-opening.

I've been wanting to bring up a related issue that is not easy to discuss. That is, how much of the morbidity in the adult deformity surgeries is due to waiting too long? How much better would the outcome be if the surgery had happened years earlier when the curve was smaller and there was less ancillary damage and the bones very stronger and the patient was younger?

I realize the paradigm is to exhaust all conservative avenues first and to hold surgery as a last resort. But I wonder if the outcomes would be better if the surgery was done not as a last resort. I am sure there is hardly any data because everyone waits until the last minute and I am not saying I would not exhaust all other options. I am just saying that just like most kids do pretty well over the years with this surgery, maybe adults would also do better if they got surgery earlier in the course of the disease.

Maybe the surgery gets a worse reputation than it might otherwise if it was a first resort.

Just throwing that out there. Surgery will always have risks so it will never be a first resort. But maybe the outcomes would improve if it was done sooner rather than later like in kids and especially in kids with TL curves with the goal to save lumbar levels.