{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:01:02Z","timestamp":1772827262836,"version":"3.50.1"},"reference-count":84,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,5]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The objective of this study was to introduce and evaluate foraminoplastic inferior pedicle subtraction osteotomy (FiPSO), a novel technique that involves downward resection of the pedicle and vertebral body, aimed at addressing rigid lower lumbar kyphosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The clinical records were reviewed of the patients who underwent corrective surgery from January 2012 through December 2021 for adult spinal deformity using a combination of procedures: pedicle subtraction osteotomy (PSO) at the lumbar level and spinopelvic fixation. Inclusion criteria included patients older than 40 years with sagittal imbalance symptoms and significant radiographic findings: sagittal vertical axis (SVA) &gt; 50 mm, pelvic tilt (PT) &gt; 25\u00b0, or pelvic incidence (PI) minus lumbar lordosis (LL) &gt; 10\u00b0. Patients were categorized into three groups: L1\u20133 PSO, L4\u2013S1 PSO, and FiPSO. The authors assessed thoracic kyphosis, LL, lower LL (LLL), PI, PT, sacral slope, SVA, global tilt (GT), and Global Alignment and Proportion (GAP) score preoperatively, postoperatively, and at the last follow-up. Complications were also analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 65 patients were included in the final analysis: 25 in the L1\u20133 PSO group, 29 in the L4\u2013S1 PSO group, and 11 in the FiPSO group. The FiPSO group showed significantly larger postoperative LLL (39.2\u00b0 \u00b1 7.7\u00b0 vs 29.7\u00b0 \u00b1 10.7\u00b0, p &lt; 0.05) and smaller PI-LL mismatch (9.6\u00b0 \u00b1 10.3\u00b0 vs 24.6\u00b0 \u00b1 13.4\u00b0, p &lt; 0.01) compared to the L4\u2013S1 PSO groups. At the last follow-up, the FiPSO group maintained larger LLL (38.3\u00b0 \u00b1 8.9\u00b0 vs 27.1\u00b0 \u00b1 10.0\u00b0, p &lt; 0.05), lower PT (23.1\u00b0 \u00b1 9.9\u00b0 vs 33.3\u00b0 \u00b1 10.7\u00b0, p &lt; 0.05), and good global sagittal alignment (SVA, 64.0 \u00b1 43.8 mm vs 106.8 \u00b1 55.7 mm, p &lt; 0.05; GT, 28.7\u00b0 \u00b1 13.9\u00b0 vs 43.5\u00b0 \u00b1 15.5\u00b0, p &lt; 0.05) compared to the L4\u2013S1 PSO group. The FiPSO group had higher nerve deficits (45%) but lower proximal junctional kyphosis (18%) and revision surgery rates (9.1%) than the L1\u20133 or L4\u2013S1 PSO groups. However, the differences were not statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>FiPSO provides effective lower lumbar correction and long-term sagittal alignment with comparable complication rates, offering a valuable option for overcoming the challenges associated with PSO in the lower lumbar spine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.4.spine241232","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:34:50Z","timestamp":1757687690000},"page":"624-632","source":"Crossref","is-referenced-by-count":0,"title":["Foraminoplastic inferior pedicle subtraction osteotomy: a novel pedicle subtraction osteotomy technique for adult spinal deformity with radiographic outcomes and complications"],"prefix":"10.3171","volume":"43","author":[{"given":"Mitsuhiro","family":"Nishizawa","sequence":"first","affiliation":[{"name":"Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junichi","family":"Ohya","sequence":"additional","affiliation":[{"name":"Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soichiro","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sun","family":"Zhongyuan","sequence":"additional","affiliation":[{"name":"Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marika G.","family":"Rosenfeld","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Onishi","sequence":"additional","affiliation":[{"name":"Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junichi","family":"Kunogi","sequence":"additional","affiliation":[{"name":"Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naohiro","family":"Kawamura","sequence":"additional","affiliation":[{"name":"Department of Spine and Orthopaedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"1317","article-title":"Lumbar degenerative kyphosis. 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