{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:23:33Z","timestamp":1792513413212,"version":"4.5.0"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2012,6]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Pedicle subtraction osteotomy (PSO) is a surgical procedure that is frequently performed on patients with sagittal spinopelvic malalignment. Although it allows for substantial spinopelvic realignment, suboptimal realignment outcomes have been reported in up to 33% of patients. The authors' objective in the present study was to identify differences in radiographic profiles and surgical procedures between patients achieving successful versus failed spinopelvic realignment following PSO.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This study is a multicenter retrospective consecutive PSO case series. The authors evaluated 99 cases involving patients who underwent PSO for sagittal spinopelvic malalignment. Because precise cutoffs of acceptable residual postoperative sagittal vertical axis (SVA) values have not been well defined, comparisons were focused between patient groups with a postoperative SVA that could be clearly considered either a success or a failure. Only cases in which the patients had a postoperative SVA of less than 50 mm (successful PSO realignment) or more than 100 mm (failed PSO realignment) were included in the analysis. Radiographic measures and PSO parameters were compared between successful and failed PSO realignments.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Seventy-nine patients met the inclusion criteria. Successful realignment was achieved in 61 patients (77%), while realignment failed in 18 (23%). Patients with failed realignment had larger preoperative SVA (mean 217.9 vs 106.7 mm, p &lt; 0.01), larger pelvic tilt (mean 36.9\u00b0 vs 30.7\u00b0, p &lt; 0.01), larger pelvic incidence (mean 64.2\u00b0 vs 53.7\u00b0, p &lt; 0.01), and greater lumbar lordosis\u2013pelvic incidence mismatch (\u221247.1\u00b0 vs \u221230.9\u00b0, p &lt; 0.01) compared with those in whom realignment was successful. Failed and successful realignments were similar regarding the vertebral level of the PSO, the median size of wedge resection 22.0\u00b0 (interquartile range 16.5\u00b0\u221228.5\u00b0), and the numerical changes in pre- and postoperative spinopelvic parameters (p &gt; 0.05).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Patients with failed PSO realignments had significantly larger preoperative spinopelvic deformity than patients in whom realignment was successful. Despite their apparent need for greater correction, the patients in the failed realignment group only received the same amount of correction as those in the successfully realigned patients. A single-level standard PSO may not achieve optimal outcome in patients with high preoperative spinopelvic sagittal malalignment. Patients with large spinopelvic deformities should receive larger osteotomies or additional corrective procedures beyond PSOs to avoid undercorrection.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.2.spine11120","type":"journal-article","created":{"date-parts":[[2012,3,30]],"date-time":"2012-03-30T14:44:23Z","timestamp":1333118663000},"page":"539-546","source":"Crossref","is-referenced-by-count":111,"title":["Sagittal realignment failures following pedicle subtraction osteotomy surgery: are we doing enough?"],"prefix":"10.3171","volume":"16","author":[{"given":"Frank J.","family":"Schwab","sequence":"first","affiliation":[{"name":"1Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Patel","sequence":"additional","affiliation":[{"name":"1Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"2Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Pierre","family":"Farcy","sequence":"additional","affiliation":[{"name":"1Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oheneba","family":"Boachie-Adjei","sequence":"additional","affiliation":[{"name":"3Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Hostin","sequence":"additional","affiliation":[{"name":"4Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Hart","sequence":"additional","affiliation":[{"name":"5Department of Orthopedic Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behrooz A.","family":"Akbarnia","sequence":"additional","affiliation":[{"name":"6Orthopedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas C.","family":"Burton","sequence":"additional","affiliation":[{"name":"7Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"8Orthopedic Surgery, Rocky Mountain Scoliosis and Spine, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"1Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine11120","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31817c0466"},{"key":"b2-spine11120","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000199893.71141.59"},{"issue":"306","key":"b3-spine11120","first-page":"64","author":"Bradford DS","year":"1994","journal-title":"Clin Orthop Relat 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