This is the follow-up on a previously presented case of severe lumbar sagittal malalignment — a patient who had been living with progressive forward imbalance that significantly impaired her quality of life and ability to stand upright.
After comprehensive preoperative evaluation and medical optimization, the patient underwent posterior spinal instrumentation from T12 to S1/pelvis, with a transforaminal lumbar interbody fusion (TLIF) at L5-S1 and a pedicle subtraction osteotomy (PSO) at L5. The PSO allowed correction of the severe sagittal imbalance by removing a posterior and middle column wedge of bone at L5, enabling the spine to be repositioned into a balanced, upright alignment.
The results at long-term follow-up have been excellent. The patient is now able to stand upright comfortably — something she had not been able to do for decades. She has expressed significant gratitude for the outcome and remains neurologically intact with a solid fusion construct on imaging.
This case illustrates several important principles in adult spinal deformity surgery: the importance of addressing sagittal balance rather than coronal deformity alone, the role of three-column osteotomy in correcting fixed deformity, and the durability of well-executed reconstruction over the long term.
Case presented for educational purposes with patient consent. This post does not constitute individualized medical advice. If you are experiencing difficulty standing upright or progressive spinal deformity, consult a qualified spine specialist.
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Sardar Spine | NYC Spinal Deformity & Scoliosis Surgeon 