A year or so ago, I performed a major surgery on a patient with severe thoracolumbar kyphosis, the name of which was: PSO osteotomy orthopedic long-segment fixation and fusion of the thoracolumbar kyphosis of the spine. The spine, when viewed from the side, has a physiological curvature but appears to be straight overall, like a straight pine tree, and the ancient saying of standing like a pine describes the human standing posture. The thoracic and lumbar segments of the spine are deformed, refers to the junction of the thoracic and lumbar segments of the spine appears backward bulge, the bulge above the spine to the front of the body, somewhat like the commonly known “gong pot child”. Among the elderly, we often see the poor situation of reduced height, back convexity, forward leaning body, and eyes only looking at the ground. Indeed, the back convexity to a certain extent, the eyes can only look at the ground, to see the front will have to force back the head, look at a while, and then immediately lower the head, because it is too tired! And, there is much more than that. Increased stress in the posterior convexity leads to intractable pain, spasmodic pain in the muscles of the posterior spine in a state of prolonged stretching, and intense radiating pain due to structural changes in the spine that compress the nerves, which can affect activities, rest, sleep, in short, all the time, and also gradually worsen. Such patients often feel that life is meaningless! In addition to pain, the forward-flexed spine can compress the lung lobes in front of the spine, the heart and even the intestinal canal in the abdominal cavity, affecting the physiological functions of these organs. Faced with such a patient, I had to perform a major surgery on him. The full name of the surgery is: PSO osteotomy orthopedic long-segment fixation and fusion of the thoracolumbar segment of the spine. In simple terms, the most severely kyphotic vertebra is the one with the most severe kyphosis, and a portion of the posterior vertebra is amputated so that the front and back of the vertebra are basically the same height, which will correct the anteriorly inclined spine. This is not enough, but bone particles must be laid on the back or side of the spine to allow the spine to eventually fuse in this relatively normal position. Without going into the details, anyway, this patient had a wound in the back of the body that was approximately 30+ cm in length, approximately 1200 ml of intraoperative bleeding, and a total of 18 pedicle screws. This is not a small operation, no matter who it is for. However, there was a chance that this surgery could have been avoided. The patient, an elderly woman, was 70 years old and thin. She had a background in medicine, was tall, had a wide range of hobbies, and participated in many social activities after retirement. One day, she had a fall, which was not serious, but afterwards she felt pain in her back and a month later, she went to the hospital to have a compression fracture of the 12 thoracic vertebrae (compression quarter). Compression fractures are mostly seen in the elderly, due to osteoporosis, the strength and stiffness of the vertebral body decreases and cannot bear the fluctuation of the spinal load, resulting in the compression of the anterior edge of the vertebral body under minor violence, and the side of the vertebral body turns into a trapezoid from the original square. The principles of treatment for compression fractures turned out to be: bed rest to reduce weight bearing on the fractured vertebrae of the spine for 2 months, thoracolumbar support when you have to get up, symptomatic pain relief, and active and comprehensive strict anti-osteoporosis treatment. But this process is long and painful, and there are many complications: pneumonia, urinary tract infections, blood clots, and further aggravation of osteoporosis due to immobility. Based on this, there is now a new treatment called vertebroplasty and kyphoplasty. In simple terms, a thin tube is inserted into the fractured vertebral body percutaneously under local anesthesia, and then something called “bone cement” is injected into the vertebral body through the tube. A support system is formed within the vertebral body to maintain the fracture in place. The procedure takes about 20-30 minutes, the wound is so small that no stitches are needed, and it can be done under local anesthesia. The benefits: the pain relief is immediate, with the patient experiencing about 80-90% pain relief and strengthening of the vertebrae after two hours. In the near term, the long painful fracture process is terminated and the patient does not have to be bedridden for 2 months; in the long term, medical diseases caused by bedriddenness are reduced and the vicious cycle of osteoporosis aggravation after braking is broken; another very important point, which is related to the major surgery mentioned above today, is that after the vertebral body is strengthened, the pace of continued aggravation of vertebral compression is stopped, or at least significantly slowed down, and major surgery can be avoided. Surgery. I told all this information to my patient. Since she had studied medicine, she understood the previous treatments, so she chose only the previous treatment: bed rest for 2 months to reduce weight bearing on the fractured vertebrae of the spine, thoracolumbar support when she had to get up, symptomatic pain relief, and aggressive, comprehensive and strict anti-osteoporosis treatment. Later, at the follow-up visit, according to her, she fully met the requirements of bed rest and medication. However, her vertebral compression continued to worsen, and her kyphosis became more and more severe, and the situation described earlier in the article appeared. At the X-ray taken six months later, the height of the anterior wall of her thoracic 12 vertebrae basically disappeared, and when viewed from the side, the thoracic 12 vertebrae was a triangle, and severe kyphosis inevitably occurred, with inability to look ahead, low back pain, muscle spasm pain, neuralgia, dyspnea, etc. Symptoms, just like those written in textbooks, appear. What to do? Only to have a major surgery that would have had a chance to be avoided. This case tells us 3 things: 1. Today, with the continuous development of medicine, there are many new methods and procedures that can solve and relieve our pain; 2. Sometimes it will be counterproductive, misjudging the condition and decreasing compliance with the doctor’s correct guidance, etc.; 3. I believe that every doctor is willing to cure his/her patients, and to put it in practical terms, this is true for the sake of profit. Specifically for this patient, although the recovery after the major surgery was good and very satisfactory. But there was a twinge of guilt in my heart because I had the opportunity to convince her to undergo that minor surgery and avoid this major one, which for whatever reason I failed to do.