{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:45:41Z","timestamp":1786124741501,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2019,1,23]],"date-time":"2019-01-23T00:00:00Z","timestamp":1548201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND AND IMPORTANCE<\/jats:title>\n                    <jats:p>Pedicle subtraction osteotomy (PSO) is a 3-column osteotomy used to correct rigid, large magnitude sagittal spinal deformity. PSO is an inherently destabilizing procedure intraoperatively, with high risk of neurological deficits from vertebral body subluxation or translation during osteotomy closure. Traditionally, PSO closure has been performed utilizing compression or cantilevering forces across adjacent level instrumentation. Such forces can loosen the instrumentation or cause abrupt subluxation or translation due to the magnitude of force required for PSO closure, resulting in neurological injury. Here, we report using a flexible hinge-powered operating table for controlled closure of PSO in 1\u00ba increments via remote-control power of the table, without compression or cantilevering force required across implants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CLINICAL PRESENTATION<\/jats:title>\n                    <jats:p>The patient is a 68-yr-old man with a history of prior L2-S1 anterior-posterior fusion, healed sacral fracture, and left sacroiliac joint fusion presenting to our institution with severe back pain while standing. X-rays demonstrated significant sagittal malalignment with pelvic incidence (PI) of 79\u00ba and lumbar lordosis (LL) of 37\u00ba, while computed tomography scan confirms complete bone healing around prior interbody fusion sites, resulting in rigid sagittal deformity. Due to rigid PI-LL mismatch of 42\u00ba, we planned for L2-pelvis revision fusion with L4 PSO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Here we demonstrate the utility of a flexible hinge-powered operating table for closure of PSO site. This technique eliminates force application to adjacent implants, minimizing vertebral body subluxation, or translation. We believe this allows for safer, more controllable osteotomy closure that minimizes risk of neurological injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opy397","type":"journal-article","created":{"date-parts":[[2019,1,24]],"date-time":"2019-01-24T13:45:33Z","timestamp":1548337533000},"page":"E214-E218","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Controlled Pedicle Subtraction Osteotomy Site Closure Using Flexible Hinge-Powered Operating Table"],"prefix":"10.1227","volume":"17","author":[{"given":"Kristen E","family":"Jones","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A","family":"Hunt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher T","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W","family":"Polly","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota"},{"name":"Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,11]]},"reference":[{"issue":"Suppl 1","key":"bib1-20240909","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1227\/01.neu.0000462076.73701.09","article-title":"The comprehensive anatomical spinal osteotomy 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assessment","volume":"32","author":"Buchowski","year":"2007","journal-title":"Spine"},{"issue":"17","key":"bib5-20240909","doi-asserted-by":"crossref","first-page":"E599","DOI":"10.1097\/BRS.0b013e3181aad219","article-title":"Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity","volume":"34","author":"Lafage","year":"2009","journal-title":"Spine"},{"issue":"1","key":"bib6-20240909","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s13013-016-0081-z","article-title":"Utilization trends of pedicle subtraction osteotomies compared to posterior spinal fusion for deformity: a national database analysis between 2008\u20132011","volume":"11","author":"Gum","year":"2016","journal-title":"Scoliosis"},{"issue":"4","key":"bib7-20240909","doi-asserted-by":"crossref","first-page":"444","DOI":"10.3171\/2016.10.SPINE16849","article-title":"Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up","volume":"27","author":"Smith","year":"2017","journal-title":"J Neurosurg Spine"},{"issue":"13","key":"bib8-20240909","doi-asserted-by":"crossref","first-page":"E795","DOI":"10.1097\/BRS.0000000000001958","article-title":"Surgical and radiographic outcomes after pedicle subtraction osteotomy according to surgeon's experience","volume":"42","author":"Choi","year":"2017","journal-title":"Spine"},{"issue":"4","key":"bib9-20240909","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1093\/ons\/opx151","article-title":"A novel 4-Rod technique offers potential to reduce rod breakage and pseudarthrosis in pedicle subtraction osteotomies for adult spinal deformity correction","volume":"14","author":"Gupta","year":"2018","journal-title":"Oper Neurosurg"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/17\/5\/E214\/30092243\/opy397.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opy397","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:45:03Z","timestamp":1786121103000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opy397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,23]]},"references-count":9,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opy397","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,23]]},"assertion":[{"value":"2018-04-25","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-29","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}