I am an Asian American, born and raised in the U.S. My grandparents are still in China and continue to work in the fields despite old age and poor health. Grandmother is especially frail with a very stooped posture. Should I try and convince her to come here for surgery? I understand a spinal fusion could really help her.

Your grandmother may have a condition referred to as lumbar degenerative kyphosis (LDK). A flat low back and compensatory curved upper back results in a stooped posture. In an effort to keep the face and eyes on a level track, the patient may bend the knees while the head and neck hyperextend.

In this condition, the discs between the vertebrae thin out. The bodies of the vertebral bones start to collapse. The presence of osteoporosis (brittle bones) so common in older adults compounds the problem.

Spinal surgery for LDK depends on several factors. The patient's symptoms and severity of the problem are important. But even more importantly is the patient's desite to correct the deformity. Old age, poor bone quality, and lifestyle are negatvie factors and must be taken into consideration.

If the patient can't adapt to changes in lifestyle after the surgery, then the results may not be worth the time, cost, and effort. Squatting must be replaced by sitting in a chair. Sleeping in a bed is advised. Working in the fields may no longer be possible.