{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:35:08Z","timestamp":1788568508395,"version":"build-2803163510"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Fixed sagittal spinal malalignment is a common problem in adult spinal deformity (ASD). Various three-column osteotomy techniques, including the extended pedicle subtraction osteotomy (ePSO), may correct global and regional malalignment in this patient population. In contrast to the number of reports on traditional PSO (Schwab grade 3 osteotomy), there is limited literature on the outcomes of ePSO (Schwab grade 4 osteotomy) in ASD surgery. The objective of this retrospective study was to provide focused investigation of radiographic outcomes and complications of single-level lumbar ePSO for ASD patients with fixed sagittal malalignment.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Consecutive ASD patients in whom sagittal malalignment had been treated with single-level lumbar ePSO at the authors\u2019 institution between 2010 and 2015 were analyzed, and those with a minimum 2-year follow-up were included in the study. Radiographic analyses included assessments of segmental lordosis through the ePSO site (sagittal Cobb angle measured from the superior endplate of the vertebra above and inferior endplate of the vertebra below the ePSO), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence and LL mismatch, thoracic kyphosis (TK), and sagittal vertical axis (SVA) on standing long-cassette radiographs. Complications were analyzed for the entire group.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Among 71 potentially eligible patients, 55 (77%) had a minimum 2-year follow-up and were included in the study. Overall, the average postoperative increases in ePSO segmental lordosis and overall LL were 41\u00b0 \u00b1 14\u00b0 (range 7\u00b0\u201369\u00b0, p &lt; 0.001) and 38\u00b0 \u00b1 11\u00b0 (range 9\u00b0\u201358\u00b0, p &lt; 0.001), respectively. The average SVA improvement was 13 \u00b1 7 cm (range of correction: \u221233.6 to 3.4 cm, p &lt; 0.001). These measurements were maintained when comparing early postoperative to last follow-up values, respectively (mean follow-up 52 months, range 26\u201397 months): ePSO segmental lordosis, 34\u00b0 vs 33\u00b0, p = 0.270; LL, 47.3\u00b0 vs 46.7\u00b0, p = 0.339; and SVA, 4 vs 5 cm, p = 0.330. Rod fracture (RF) at the ePSO site occurred in 18.2% (10\/55) of patients, and pseudarthrosis (PA) at the ePSO site was confirmed by CT imaging or during rod revision surgery in 14.5% (8\/55) of patients. Accessory supplemental rods across the ePSO site, a more recently employed technique, significantly reduced the occurrence of RF or PA on univariate (p = 0.004) and multivariable (OR 0.062, 95% CI 0.007\u20130.553, p = 0.013) analyses; this effect approached statistical significance on Kaplan-Meier analysis (p = 0.053, log-rank test). Interbody cage placement at the ePSO site resulted in greater ePSO segmental lordosis correction (45\u00b0 vs 35\u00b0, p = 0.007) without significant change in RF or PA (p = 0.304). Transient and persistent motor deficits occurred in 14.5% (8\/55) and 1.8% (1\/55) of patients, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Extended PSO is an effective technique to correct fixed sagittal malalignment for ASD. In comparison to traditional PSO techniques, ePSO may allow greater focal correction with comparable complication rates, especially with interbody cage placement at the ePSO site and the use of accessory supplemental rods.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.7.spine171367","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T17:38:51Z","timestamp":1542389931000},"page":"242-252","source":"Crossref","is-referenced-by-count":33,"title":["Radiographic outcome and complications after single-level lumbar extended pedicle subtraction osteotomy for fixed sagittal malalignment: a retrospective analysis of 55 adult spinal deformity patients with a minimum 2-year follow-up"],"prefix":"10.3171","volume":"30","author":[{"given":"Thomas J.","family":"Buell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James H.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus D.","family":"Mazur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Mullin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juanita","family":"Garces","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davis G.","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Po","family":"Yen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Shaffrey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2036","DOI":"10.1097\/00007632-200109150-00020","article-title":"Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy","volume":"26","author":"Berven SH","year":"2001","unstructured":"Berven SH, Deviren V, Smith JA, Emami A, Hu SS, Bradford DS: Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine (Phila Pa 1976) 26:2036\u20132043, 200110.1097\/00007632-200109150-0002011547205"},{"key":"b2","series-title":"Instr Course Lect","first-page":"583","article-title":"Role and technique of eggshell osteotomies and vertebral column resections in the treatment of fixed sagittal imbalance","volume":"55","author":"Boachie-Adjei O","year":"2006","unstructured":"Boachie-Adjei O: Role and technique of eggshell osteotomies and vertebral column resections in the treatment of fixed sagittal imbalance. Instr Course Lect 55:583\u2013589, 200616958491"},{"key":"b3","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1712","DOI":"10.1097\/00007632-199908150-00013","article-title":"Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance)","volume":"24","author":"Booth KC","year":"1999","unstructured":"Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM: Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine (Phila Pa 1976) 24:1712\u20131720, 199910.1097\/00007632-199908150-0001310472106"},{"issue":"306","key":"b4","series-title":"Clin Orthop Relat Res","first-page":"64","article-title":"Current concepts and management of patients with fixed decompensated spinal deformity","author":"Bradford DS","year":"1994","unstructured":"Bradford DS, Tribus CB: Current concepts and management of patients with fixed decompensated spinal deformity. Clin Orthop Relat Res (306):64\u201372, 19948070213"},{"key":"b5","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1097\/01.BRS.0000090891.60232.70","article-title":"Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance","volume":"28","author":"Bridwell KH","year":"2003","unstructured":"Bridwell KH, Lewis SJ, Edwards C, Lenke LG, Iffrig TM, Berra A, : Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976) 28:2093\u20132101, 20031450192010.1097\/01.BRS.0000090891.60232.70"},{"key":"b6","series-title":"J Bone Joint Surg Am 85-A","doi-asserted-by":"publisher","first-page":"454","DOI":"10.2106\/00004623-200303000-00009","article-title":"Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance","author":"Bridwell KH","year":"2003","unstructured":"Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K: Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85-A:454\u2013463, 200310.2106\/00004623-200303000-00009"},{"issue":"Suppl 1","key":"b7","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"44","DOI":"10.2106\/00004623-200400001-00007","article-title":"Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique","volume":"86-A","author":"Bridwell KH","year":"2004","unstructured":"Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K: Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Am 86-A (Suppl 1):44\u201350, 200410.2106\/00004623-200400001-00007"},{"key":"b8","series-title":"Oper Neurosurg (Hagerstown)","article-title":"A pilot study on posterior polyethylene tethers to prevent proximal junctional kyphosis after multilevel spinal instrumentation for adult spinal deformity","author":"Buell TJ","unstructured":"Buell TJ, Buchholz AL, Quinn JC, Bess S, Line BG, Ames CP, : A pilot study on posterior polyethylene tethers to prevent proximal junctional kyphosis after multilevel spinal instrumentation for adult spinal deformity. Oper Neurosurg (Hagerstown) [epub ahead of print], 201829688555"},{"key":"b9","series-title":"Oper Neurosurg (Hagerstown)","article-title":"Extended asymmetrical pedicle subtraction osteotomy for adult spinal deformity: 2-dimensional operative video","author":"Buell TJ","unstructured":"Buell TJ, Buchholz AL, Quinn JC, Mullin JP, Garces J, Mazur MD, : Extended asymmetrical pedicle subtraction osteotomy for adult spinal deformity: 2-dimensional operative video. Oper Neurosurg (Hagerstown) [epub ahead of print], 201829920605"},{"key":"b10","series-title":"World Neurosurg","article-title":"Alignment risk factors for proximal junctional kyphosis and the effect of lower thoracic junctional tethers for adult spinal deformity","author":"Buell TJ","year":"2018","unstructured":"Buell TJ, Chen CJ, Quinn JC, Buchholz AL, Mazur MD, Mullin JP, : Alignment risk factors for proximal junctional kyphosis and the effect of lower thoracic junctional tethers for adult spinal deformity. World Neurosurg [epub ahead of print], 201830217780"},{"key":"b11","series-title":"Oper Neurosurg (Hagerstown)","article-title":"A novel junctional tether weave technique for adult spinal deformity: 2-dimensional operative video","author":"Buell TJ","unstructured":"Buell TJ, Mullin JP, Nguyen JH, Taylor DG, Garces J, Mazur MD, : A novel junctional tether weave technique for adult spinal deformity: 2-dimensional operative video. Oper Neurosurg (Hagerstown) [epub ahead of print], 201829873786"},{"key":"b12","series-title":"Instr Course Lect","first-page":"577","article-title":"Smith-Petersen osteotomy of the spine","volume":"55","author":"Burton DC","year":"2006","unstructured":"Burton DC: Smith-Petersen osteotomy of the spine. Instr Course Lect 55:577\u2013582, 200616958490"},{"key":"b13","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1097\/00007632-198710000-00007","article-title":"The effect of Harrington rod contouring on lumbar lordosis","volume":"12","author":"Casey MP","year":"1987","unstructured":"Casey MP, Asher MA, Jacobs RR, Orrick JM: The effect of Harrington rod contouring on lumbar lordosis. Spine (Phila Pa 1976) 12:750\u2013753, 1987368623110.1097\/00007632-198710000-00007"},{"key":"b14","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1097\/BRS.0b013e31822ff5c1","article-title":"Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients","volume":"37","author":"Charosky S","year":"2012","unstructured":"Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D: Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine (Phila Pa 1976) 37:693\u2013700, 20122250451710.1097\/BRS.0b013e31822ff5c1"},{"key":"b15","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2030","DOI":"10.1097\/01.brs.0000179085.92998.ee","article-title":"Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance","volume":"30","author":"Cho KJ","year":"2005","unstructured":"Cho KJ, Bridwell KH, Lenke LG, Berra A, Baldus C: Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976) 30:2030\u20132038, 200510.1097\/01.brs.0000179085.92998.ee16166890"},{"key":"b16","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E1561","DOI":"10.1097\/BRS.0b013e3182a63c29","article-title":"Pedicle subtraction osteotomy in elderly patients with degenerative sagittal imbalance","volume":"38","author":"Cho KJ","year":"2013","unstructured":"Cho KJ, Kim KT, Kim WJ, Lee SH, Jung JH, Kim YT, : Pedicle subtraction osteotomy in elderly patients with degenerative sagittal imbalance. Spine (Phila Pa 1976) 38:E1561\u2013E1566, 201310.1097\/BRS.0b013e3182a63c29"},{"key":"b17","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E795","DOI":"10.1097\/BRS.0000000000001958","article-title":"Surgical and radiographic outcomes after pedicle subtraction osteotomy according to surgeon\u2019s experience","volume":"42","author":"Choi HY","year":"2017","unstructured":"Choi HY, Hyun SJ, Kim KJ, Jahng TA, Kim HJ: Surgical and radiographic outcomes after pedicle subtraction osteotomy according to surgeon\u2019s experience. Spine (Phila Pa 1976) 42:E795\u2013E801, 201710.1097\/BRS.0000000000001958"},{"key":"b18","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.2106\/00004623-197961080-00003","article-title":"Reconstructive surgery in the adult for failed scoliosis fusion","volume":"61","author":"Cummine JL","year":"1979","unstructured":"Cummine JL, Lonstein JE, Moe JH, Winter RB, Bradford DS: Reconstructive surgery in the adult for failed scoliosis fusion. J Bone Joint Surg Am 61:1151\u20131161, 197910.2106\/00004623-197961080-00003511876"},{"key":"b19","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1097\/BRS.0000000000000380","article-title":"Risk factors for and assessment of symptomatic pseudarthrosis after lumbar pedicle subtraction osteotomy in adult spinal deformity","volume":"39","author":"Dickson DD","year":"2014","unstructured":"Dickson DD, Lenke LG, Bridwell KH, Koester LA: Risk factors for and assessment of symptomatic pseudarthrosis after lumbar pedicle subtraction osteotomy in adult spinal deformity. Spine (Phila Pa 1976) 39:1190\u20131195, 20142517106710.1097\/BRS.0000000000000380"},{"key":"b20","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"56","DOI":"10.3171\/2016.12.SPINE16585","article-title":"Pedicle subtraction osteotomy: a comprehensive analysis in 104 patients. Does the cause of deformity influence the outcome?","volume":"27","author":"Eskilsson K","year":"2017","unstructured":"Eskilsson K, Sharma D, Johansson C, Hedlund R: Pedicle subtraction osteotomy: a comprehensive analysis in 104 patients. Does the cause of deformity influence the outcome? J Neurosurg Spine 27:56\u201362, 201710.3171\/2016.12.SPINE1658528475018"},{"key":"b21","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2452","DOI":"10.1097\/00007632-199710150-00025","article-title":"Management of flatback and related kyphotic decompensation syndromes","volume":"22","author":"Farcy JP","year":"1997","unstructured":"Farcy JP, Schwab FJ: Management of flatback and related kyphotic decompensation syndromes. Spine (Phila Pa 1976) 22:2452\u20132457, 1997935522910.1097\/00007632-199710150-00025"},{"key":"b22","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"2509","DOI":"10.2106\/JBJS.H.00081","article-title":"Corrective osteotomies in spine surgery","volume":"90","author":"Gill JB","year":"2008","unstructured":"Gill JB, Levin A, Burd T, Longley M: Corrective osteotomies in spine surgery. J Bone Joint Surg Am 90:2509\u20132520, 20081897842110.2106\/JBJS.H.00081"},{"key":"b23","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1097\/01.brs.0000155425.04536.f7","article-title":"Correlation of radiographic parameters and clinical symptoms in adult scoliosis","volume":"30","author":"Glassman SD","year":"2005","unstructured":"Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR: Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 30:682\u2013688, 20051577018510.1097\/01.brs.0000155425.04536.f7"},{"key":"b24","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2024","DOI":"10.1097\/01.brs.0000179086.30449.96","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"Glassman SD","year":"2005","unstructured":"Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F: The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30:2024\u20132029, 20051616688910.1097\/01.brs.0000179086.30449.96"},{"key":"b25","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E1169","DOI":"10.1097\/BRS.0000000000001107","article-title":"Pedicle subtraction osteotomy in the revision versus primary adult spinal deformity patient: is there a difference in correction and complications?","volume":"40","author":"Gupta MC","year":"2015","unstructured":"Gupta MC, Ferrero E, Mundis G, Smith JS, Shaffrey CI, Schwab F, : Pedicle subtraction osteotomy in the revision versus primary adult spinal deformity patient: is there a difference in correction and complications? Spine (Phila Pa 1976) 40:E1169\u2013E1175, 201510.1097\/BRS.0000000000001107"},{"key":"b26","series-title":"Oper Neurosurg (Hagerstown)","doi-asserted-by":"publisher","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 S","year":"2018","unstructured":"Gupta S, Eksi MS, Ames CP, Deviren V, Durbin-Johnson B, Smith JS, : A novel 4-rod technique offers potential to reduce rod breakage and pseudarthrosis in pedicle subtraction osteotomies for adult spinal deformity correction. Oper Neurosurg (Hagerstown) 14:449\u2013456, 20182897365810.1093\/ons\/opx151"},{"key":"b27","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1899","DOI":"10.1097\/BRS.0000000000000556","article-title":"Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies","volume":"39","author":"Hyun SJ","year":"2014","unstructured":"Hyun SJ, Lenke LG, Kim YC, Koester LA, Blanke KM: Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976) 39:1899\u20131904, 201410.1097\/BRS.000000000000055625299168"},{"key":"b28","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1097\/BRS.0000000000000526","article-title":"Results of revision surgery after pedicle subtraction osteotomy for fixed sagittal imbalance with pseudarthrosis at the prior osteotomy site or elsewhere: minimum 5 years post-revision","volume":"39","author":"Kim YC","year":"2014","unstructured":"Kim YC, Lenke LG, Hyun SJ, Lee JH, Koester LA, Blanke KM: Results of revision surgery after pedicle subtraction osteotomy for fixed sagittal imbalance with pseudarthrosis at the prior osteotomy site or elsewhere: minimum 5 years post-revision. Spine (Phila Pa 1976) 39:1817\u20131828, 20142505465210.1097\/BRS.0000000000000526"},{"key":"b29","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2189","DOI":"10.1097\/BRS.0b013e31814b8371","article-title":"Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study","volume":"32","author":"Kim YJ","year":"2007","unstructured":"Kim YJ, Bridwell KH, Lenke LG, Cheh G, Baldus C: Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976) 32:2189\u20132197, 20071787381010.1097\/BRS.0b013e31814b8371"},{"key":"b30","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"184","DOI":"10.3171\/2010.9.SPINE10129","article-title":"Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?","volume":"14","author":"Lafage V","year":"2011","unstructured":"Lafage V, Schwab F, Vira S, Hart R, Burton D, Smith JS, : Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine 14:184\u2013191, 201110.3171\/2010.9.SPINE1012921184642"},{"key":"b31","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"569","DOI":"10.2106\/00004623-198870040-00014","article-title":"Treatment of symptomatic flatback after spinal fusion","volume":"70","author":"Lagrone MO","year":"1988","unstructured":"Lagrone MO, Bradford DS, Moe JH, Lonstein JE, Winter RB, Ogilvie JW: Treatment of symptomatic flatback after spinal fusion. J Bone Joint Surg Am 70:569\u2013580, 198810.2106\/00004623-198870040-000143356724"},{"key":"b32","series-title":"Curr Rev Musculoskelet Med","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s12178-016-9353-8","article-title":"Proximal junctional kyphosis and failure\u2014diagnosis, prevention, and treatment","volume":"9","author":"Nguyen NL","year":"2016","unstructured":"Nguyen NL, Kong CY, Hart RA: Proximal junctional kyphosis and failure\u2014diagnosis, prevention, and treatment. Curr Rev Musculoskelet Med 9:299\u2013308, 201610.1007\/s12178-016-9353-827278530"},{"key":"b33","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E899","DOI":"10.1097\/BRS.0000000000002007","article-title":"Comparative study between pedicle subtraction osteotomy (PSO) and closing-opening wedge osteotomy (fish-mouth PSO) for sagittal plane deformity correction","volume":"42","author":"Park JH","year":"2017","unstructured":"Park JH, Hyun SJ, Kim KJ, Jahng TA: Comparative study between pedicle subtraction osteotomy (PSO) and closing-opening wedge osteotomy (fish-mouth PSO) for sagittal plane deformity correction. Spine (Phila Pa 1976) 42:E899\u2013E905, 201710.1097\/BRS.0000000000002007"},{"key":"b34","series-title":"Int Orthop","doi-asserted-by":"publisher","first-page":"1219","DOI":"10.1007\/s00264-016-3126-2","article-title":"Utility of the pedicle subtraction osteotomy for the correction of sagittal spine imbalance","volume":"40","author":"Popa I","year":"2016","unstructured":"Popa I, Oprea M, Andrei D, Mercedesz P, Mardare M, Poenaru DV: Utility of the pedicle subtraction osteotomy for the correction of sagittal spine imbalance. Int Orthop 40:1219\u20131225, 201610.1007\/s00264-016-3126-226907875"},{"key":"b35","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1227\/NEU.0000000000000182o","article-title":"The comprehensive anatomical spinal osteotomy classification","volume":"74","author":"Schwab F","year":"2014","unstructured":"Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, : The comprehensive anatomical spinal osteotomy classification. Neurosurgery 74:112\u2013120, 201410.1227\/NEU.0000000000000182o24356197"},{"key":"b36","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1097\/BRS.0b013e3181ee6bd4","article-title":"Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery","volume":"35","author":"Schwab F","year":"2010","unstructured":"Schwab F, Patel A, Ungar B, Farcy JP, Lafage V: Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35:2224\u20132231, 201010.1097\/BRS.0b013e3181ee6bd421102297"},{"key":"b37","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/00007632-200202150-00012","article-title":"Adult scoliosis: a quantitative radiographic and clinical analysis","volume":"27","author":"Schwab FJ","year":"2002","unstructured":"Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M: Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976) 27:387\u2013392, 20021184010510.1097\/00007632-200202150-00012"},{"key":"b38","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2015.11.SPINE151036","article-title":"Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery","volume":"25","author":"Smith JS","year":"2016","unstructured":"Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, : Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine 25:1\u201314, 20162691857410.3171\/2015.11.SPINE151036"},{"key":"b39","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"958","DOI":"10.1097\/BRS.0b013e3181eabb26","article-title":"Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee","volume":"36","author":"Smith JS","year":"2011","unstructured":"Smith JS, Sansur CA, Donaldson WF III, Perra JH, Mudiyam R, Choma TJ, : Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 36:958\u2013964, 201110.1097\/BRS.0b013e3181eabb2621192289"},{"key":"b40","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1227\/01.NEU.0000347005.35282.6C","article-title":"Improvement of back pain with operative and nonoperative treatment in adults with scoliosis","volume":"65","author":"Smith JS","year":"2009","unstructured":"Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, : Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 65:86\u201394, 200910.1227\/01.NEU.0000347005.35282.6C19574829"},{"key":"b41","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1097\/BRS.0b013e3181ac5fcd","article-title":"Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up","volume":"34","author":"Smith JS","year":"2009","unstructured":"Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, : Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976) 34:1693\u20131698, 200910.1097\/BRS.0b013e3181ac5fcd19770610"},{"key":"b42","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","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 JS","year":"2017","unstructured":"Smith JS, Shaffrey CI, Klineberg E, Lafage V, Schwab F, Lafage R, : 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. J Neurosurg Spine 27:444\u2013457, 20172829140210.3171\/2016.10.SPINE16849"},{"key":"b43","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"994","DOI":"10.3171\/2014.9.SPINE131176","article-title":"Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity","volume":"21","author":"Smith JS","year":"2014","unstructured":"Smith JS, Shaffrey E, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, : Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine 21:994\u20131003, 201410.3171\/2014.9.SPINE13117625325175"},{"key":"b44","series-title":"Epidemiology","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1097\/EDE.0b013e3181c30fb2","article-title":"Assessing the performance of prediction models: a framework for traditional and novel measures","volume":"21","author":"Steyerberg EW","year":"2010","unstructured":"Steyerberg EW, Vickers AJ, Cook NR, Gerds T, Gonen M, Obuchowski N, : Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology 21:128\u2013138, 201010.1097\/EDE.0b013e3181c30fb220010215"},{"key":"b45","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1227\/NEU.0b013e31827ba066","article-title":"Effect of severity of rod contour on posterior rod failure in the setting of lumbar pedicle subtraction osteotomy (PSO): a biomechanical study","volume":"72","author":"Tang JA","year":"2013","unstructured":"Tang JA, Leasure JM, Smith JS, Buckley JM, Kondrashov D, Ames CP: Effect of severity of rod contour on posterior rod failure in the setting of lumbar pedicle subtraction osteotomy (PSO): a biomechanical study. Neurosurgery 72:276\u2013283, 20132314995610.1227\/NEU.0b013e31827ba066"},{"key":"b46","series-title":"Clin Orthop Relat Res (194)","first-page":"142","article-title":"Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis","author":"Thomasen E","year":"1985","unstructured":"Thomasen E: Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res (194):142\u2013152, 1985"},{"key":"b47","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1847","DOI":"10.1097\/BRS.0b013e31825bf644","article-title":"Asymmetrical pedicle subtraction osteotomy for rigid degenerative lumbar kyphoscoliosis","volume":"37","author":"Toyone T","year":"2012","unstructured":"Toyone T, Shiboi R, Ozawa T, Inada K, Shirahata T, Kamikawa K, : Asymmetrical pedicle subtraction osteotomy for rigid degenerative lumbar kyphoscoliosis. Spine (Phila Pa 1976) 37:1847\u20131852, 201210.1097\/BRS.0b013e31825bf64422565386"},{"issue":"2 Suppl 1","key":"b48","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"ONS140","DOI":"10.1227\/01.NEU.0000249240.35731.8F","article-title":"Lumbar pedicle subtraction osteotomy","volume":"60","author":"Wang MY","year":"2007","unstructured":"Wang MY, Berven SH: Lumbar pedicle subtraction osteotomy. Neurosurgery 60 (2 Suppl 1):ONS140\u2013ONS146, 200710.1227\/01.NEU.0000249240.35731.8F"},{"key":"b49","series-title":"Spine Deform","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.jspd.2013.01.003","article-title":"Long-term clinical and radiographic outcomes of pedicle subtraction osteotomy for fixed sagittal imbalance: does level of proximal fusion affect the outcome? Minimum 5-year follow-up","volume":"1","author":"Yagi M","year":"2013","unstructured":"Yagi M, King AB, Cunningham ME, Boachie-Adjei O: Long-term clinical and radiographic outcomes of pedicle subtraction osteotomy for fixed sagittal imbalance: does level of proximal fusion affect the outcome? Minimum 5-year follow-up. Spine Deform 1:123\u2013131, 201310.1016\/j.jspd.2013.01.00327927428"},{"key":"b50","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"2622","DOI":"10.1007\/s00586-014-3574-6","article-title":"Postoperative dysesthesia in lumbar three-column resection osteotomies","volume":"25","author":"Zhang Z","year":"2016","unstructured":"Zhang Z, Wang H, Zheng W: Postoperative dysesthesia in lumbar three-column resection osteotomies. Eur Spine J 25:2622\u20132628, 20162521245210.1007\/s00586-014-3574-6"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/30\/2\/article-p242.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/30\/2\/article-p242.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/30\/2\/article-p242.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T22:30:30Z","timestamp":1681597830000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/30\/2\/article-p242.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2]]},"references-count":50,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2018.7.spine171367","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2019,2]]}}}