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Baseline patient characteristics, complications and radiographic outcomes were collected. Radiographic outcomes including thoracic kyphosis correction, overall segment correction, and global sagittal balance correction were measured using preoperative and postoperative radiographs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>19 patients with an average age of 66.9\u2009\u00b1\u20098.3\u00a0years underwent thoracic PSO, with 94.7% (<jats:italic>n<\/jats:italic>\u2009=\u200918) being females, in the setting of revision surgery. The mean thoracic kyphosis correction was 20.4\u2009\u00b1\u20098.5\u00b0. Overall segmental correction had a mean of 16.2\u2009\u00b1\u20093.9\u00b0. Global sagittal balance correction was an average of 13.9\u2009\u00b1\u200923.2\u00a0mm (mm). The median hospital stay was 4.0 (IQR: 3.0) days with a median of 1.0 (IQR: 2.0) days in the intensive care unit. 36.8% (<jats:italic>n<\/jats:italic>\u2009=\u20097) of patients had a major complication within 30\u00a0days: proximal junction kyphosis (PJK) (2), neurologic deficits (2), pneumonia (1), cardiopulmonary (1), death (1). 47.4% (<jats:italic>n<\/jats:italic>\u2009=\u20099) of patients had a major complication within 2\u00a0years: PJK (5), neurologic deficits (2), wound dehiscence\/infection (1), pneumonia (1), cardiopulmonary (1), death (2). Average follow up was 636 (range: 43\u20131320).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>While thoracic PSO can achieve successful radiographic and clinical outcomes, it is also associated with a high risk of potential major complications and mortality, such as instrumentation or junctional failure and neurologic deficits.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s43390-025-01076-1","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T20:15:31Z","timestamp":1742501731000},"page":"1241-1251","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical and radiographic outcomes of 19 proximal thoracic pedicle subtraction osteotomies for adult spinal deformity: a case series"],"prefix":"10.1007","volume":"13","author":[{"given":"Justin","family":"Bird","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell M.","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Lucasti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin C.","family":"Graham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kowalski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3196-2996","authenticated-orcid":false,"given":"Emily K.","family":"Vallee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle E.","family":"Chipman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dil V.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher L.","family":"Hamill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,20]]},"reference":[{"issue":"6","key":"1076_CR1","doi-asserted-by":"publisher","first-page":"843","DOI":"10.2106\/00004623-198769060-00008","volume":"69","author":"JA Byrd 3rd","year":"1987","unstructured":"Byrd JA 3rd, Scoles PV, Winter RB, Bradford DS, Lonstein JE, Moe JH (1987) Adult idiopathic scoliosis treated by anterior and posterior spinal fusion. 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