- Indications for Rx:
      - curves > 40-45 deg;
      - documented progression;
      - marked imbalance with a shift to one side;
      - substantial pain;

- Operative Considerations:
    - attempt to increase lordosis compared with that noted on preoperative lateral radiograph;
    - in double major curves, the structural lumbar curve should be fused to L4 even if the L5 vertebra is included in the curve (assuming 
           that spondylolisthesis is not present);

- Complications:
     - Pain due to low lumbar fusions occurs in:
            - 80 % of patients w/ arthrodesis to L5;
            - 60 % of patients w/ arthrodesis to L4;
            - 40 % of patients w/ arthrodesis to L3;
            - 30 % of patients w/ arthrodesis to L2;
     - Kyphosis:
            - can also result in narrowing of spinal canal, causing secondary spinal stenosis to develop;
     - Flat Back Syndrome:
     - Pseudarthrosis;
     - Caudad degeneration

Correction of degenerative scoliosis of the lumbar spine. A preliminary report.

The lumbosacral curve in idiopathic scoliosis. Its significance and management.

Adolescent idiopathic scoliosis. Long-term effect of instrumentation extending to the lumbar spine.