{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:07:52Z","timestamp":1779361672098,"version":"3.51.4"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"20","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,5,18]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spondyloptosis is a rare condition with many different surgical treatment options for management. Revision surgery in these cases can be complex and challenging, with little available literature to guide approaches. The authors describe the first pediatric use of a sacral pedicle subtraction osteotomy (PSO) to salvage a revision spondyloptosis case with severe scoliosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 14-year-old adolescent female presented with hyperlordotic posture and bilateral extensor hallucis longus weakness. She had an L5\u2013S1 spondyloptosis with an 80\u00b0 olisthetic scoliosis. She underwent a posterior spinal fusion from T3 to her pelvis with the Bohlman technique. Six months postoperatively, she had a broken rod treated with rod exchange and bone morphogenetic protein. Hardware failure occurred 6 months postoperatively.<\/jats:p>\n                    <jats:p>To address the progressive sagittal imbalance, lumbosacral kyphosis, and associated high shear stresses, a sacral PSO was performed. This osteotomy was performed proximal to the previous Bohlman dowel, which was well fused and then supplemented with a multirod construct including four rods and a kickstand rod.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case illustrates a complex symptomatic spondyloptosis and olisthetic scoliosis. A sacral PSO, in contrast to a revision lumbar PSO, for restoration of sagittal alignment can be utilized as a surgical salvage technique with the use of the kickstand rod.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE251020\">https:\/\/thejns.org\/doi\/10.3171\/CASE251020<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case251020","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:54:55Z","timestamp":1779108895000},"source":"Crossref","is-referenced-by-count":0,"title":["Salvage of pediatric spondyloptosis treated with sacral pedicle subtraction osteotomy: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4955-3255","authenticated-orcid":true,"given":"Sanjana","family":"Davuluri","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Neurosurgery, Shriners Children\u2019s Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7610-5528","authenticated-orcid":true,"given":"Connor","family":"Zale","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Neurosurgery, Shriners Children\u2019s Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4206-610X","authenticated-orcid":true,"given":"Amer","family":"Samdani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Neurosurgery, Shriners Children\u2019s Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua","family":"Pahys","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Neurosurgery, Shriners Children\u2019s Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5787-1201","authenticated-orcid":true,"given":"Andrea","family":"F\u00e1bregas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Neurosurgery, Shriners Children\u2019s Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0832-3683","authenticated-orcid":true,"given":"Steven","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Neurosurgery, Shriners Children\u2019s Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"J Med Case Rep","article-title":"Traumatic spondyloptosis of the lumbar spine: a case report","volume":"8","author":"Amesiya","year":"2014","unstructured":"Amesiya ROrwotho NNyati MMugarura RMwaka ES.Traumatic spondyloptosis of the lumbar spine: a case report. J Med Case Rep. 2014;8:453. doi:10.1186\/1752-1947-8-453"},{"issue":"18","key":"bib2","series-title":"Spine (Phila Pa 1976)","first-page":"2021","article-title":"Radiographic markers in spondyloptosis: implications for spondylolisthesis progression","volume":"27","author":"Curylo","year":"2002","unstructured":"Curylo LJEdwards CDeWald RW.Radiographic markers in spondyloptosis: implications for spondylolisthesis progression. Spine (Phila Pa 1976). 2002;27(18):2021-2025. doi:10.1097\/00007632-200209150-00010"},{"issue":"3","key":"bib3","series-title":"Cureus","first-page":"e36457","article-title":"Acute traumatic spondyloptosis: a case report","volume":"15","author":"Braithwaite","year":"2023","unstructured":"Braithwaite JGruber JFakhoury JKatsigiorigis GGrewal K.Acute traumatic spondyloptosis: a case report. Cureus. 2023;15(3):e36457. doi:10.7759\/cureus.36457"},{"issue":"2","key":"bib4","series-title":"Oper Neurosurg","first-page":"e84","article-title":"Sacral pedicle subtraction osteotomy for treatment of high-grade spondylolisthesis: a technical note and review of the literature","volume":"23","author":"Safaee","year":"2022","unstructured":"Safaee MMScheer JKLau DFury MDeviren VAmes CP.Sacral pedicle subtraction osteotomy for treatment of high-grade spondylolisthesis: a technical note and review of the literature. Oper Neurosurg. 2022;23(2):e84-e90. doi:10.1227\/ons.0000000000000251"},{"issue":"7","key":"bib5","series-title":"Spine (Phila Pa 1976)","first-page":"E388","article-title":"Use of supplemental short pre-contoured accessory rods and cobalt chrome alloy posterior rods reduces primary rod strain and range of motion across the pedicle subtraction osteotomy level: an in vitro biomechanical study","volume":"41","author":"Hallager","year":"2016","unstructured":"Hallager DWGehrchen MDahl BUse of supplemental short pre-contoured accessory rods and cobalt chrome alloy posterior rods reduces primary rod strain and range of motion across the pedicle subtraction osteotomy level: an in vitro biomechanical study. Spine (Phila Pa 1976). 2016;41(7):E388-E395. doi:10.1097\/BRS.0000000000001282"},{"issue":"9","key":"bib6","series-title":"Eur Spine J","first-page":"2198","article-title":"Supplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study","volume":"28","author":"Berjano","year":"2019","unstructured":"Berjano PXu MDamilano MSupplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study. Eur Spine J. 2019;28(9):2198-2207. doi:10.1007\/s00586-019-06012-2"},{"issue":"1","key":"bib7","series-title":"Global Spine J","first-page":"59","article-title":"Traumatic lumbosacral spondyloptosis: a case report and review of the literature","volume":"4","author":"Akesen","year":"2014","unstructured":"Akesen BMutlu MKara KAyd\u0131nl\u0131 U.Traumatic lumbosacral spondyloptosis: a case report and review of the literature. Global Spine J. 2014;4(1):59-62. doi:10.1055\/s-0033-1357082"},{"issue":"5","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"445","article-title":"Scoliosis in young men with spondylolysis or spondylolisthesis. a comparative study in symptomatic and asymptomatic subjects","volume":"9","author":"Libson","year":"1984","unstructured":"Libson EBloom RAShapiro Y.Scoliosis in young men with spondylolysis or spondylolisthesis. a comparative study in symptomatic and asymptomatic subjects. Spine (Phila Pa 1976). 1984;9(5):445-447. doi:10.1097\/00007632-198407000-00003"},{"issue":"1","key":"bib9","series-title":"BMC Musculoskelet Disord","first-page":"335","article-title":"Scoliosis in dysplastic spondylolisthesis: a clinical survey of 50 young patients","volume":"23","author":"Guo","year":"2022","unstructured":"Guo XGuo ZLi WScoliosis in dysplastic spondylolisthesis: a clinical survey of 50 young patients. BMC Musculoskelet Disord. 2022;23(1):335. doi:10.1186\/s12891-022-05297-7"},{"issue":"suppl 2","key":"bib10","series-title":"Eur Spine J","first-page":"S172","article-title":"AIS and spondylolisthesis","volume":"22","author":"Crostelli","year":"2013","unstructured":"Crostelli MMazza O.AIS and spondylolisthesis. Eur Spine J. 2013;22(suppl 2):S172-S184. doi:10.1007\/s00586-012-2326-8"},{"issue":"3","key":"bib11","series-title":"Int J Spine Surg","first-page":"399","article-title":"Long-term experience with reduction technique in high-grade spondylolisthesis in the young","volume":"12","author":"Sudarshan","year":"2018","unstructured":"Sudarshan PKSuthar HRVarma VKKrishnan AHegde SK.Long-term experience with reduction technique in high-grade spondylolisthesis in the young. Int J Spine Surg. 2018;12(3):399-407. doi:10.14444\/5047"},{"issue":"10","key":"bib12","series-title":"Eur Spine J","first-page":"3027","article-title":"The management of high-grade spondylolisthesis and co-existent late-onset idiopathic scoliosis","volume":"25","author":"Srivastava","year":"2016","unstructured":"Srivastava ABayley EBoszczyk BM.The management of high-grade spondylolisthesis and co-existent late-onset idiopathic scoliosis. Eur Spine J. 2016;25(10):3027-3031. doi:10.1007\/s00586-014-3519-0"},{"key":"bib13","series-title":"N Am Spine Soc J","first-page":"100516","article-title":"Lumbar pedicle subtraction osteotomy: techniques and outcomes","volume":"19","author":"Bourghli","year":"2024","unstructured":"Bourghli ABoissiere LObeid I.Lumbar pedicle subtraction osteotomy: techniques and outcomes. N Am Spine Soc J. 2024;19:100516. doi:10.1016\/j.xnsj.2024.100516"},{"issue":"194","key":"bib14","series-title":"Clin Orthop Relat Res","first-page":"142","article-title":"Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis","author":"Thomasen","year":"1985","unstructured":"Thomasen E.Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res. 1985;(194):142-152. doi:10.1097\/00003086-198504000-00019"},{"issue":"suppl 1","key":"bib15","series-title":"Eur Spine J","first-page":"S49","article-title":"Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities","volume":"24","author":"Berjano","year":"2015","unstructured":"Berjano PAebi M.Pedicle subtraction osteotomies (PSO) in the lumbar spine for sagittal deformities. Eur Spine J. 2015;24(suppl 1):S49-S57. doi:10.1007\/s00586-014-3670-7"},{"issue":"1","key":"bib16","series-title":"JBJS Essent Surg Tech","first-page":"e0028.1-11","article-title":"Pedicle subtraction osteotomy","volume":"10","author":"Gupta","year":"2020","unstructured":"Gupta MCGupta SKelly MPBridwell KH.Pedicle subtraction osteotomy. JBJS Essent Surg Tech. 2020;10(1):e0028.1-11. doi:10.2106\/JBJS.ST.19.00028"},{"key":"bib1","series-title":"J Med Case Rep","article-title":"Traumatic spondyloptosis of the lumbar spine: a case report","volume":"8","author":"Amesiya","year":"2014","unstructured":"Amesiya ROrwotho NNyati MMugarura RMwaka ES.Traumatic spondyloptosis of the lumbar spine: a case report. J Med Case Rep. 2014;8:453. doi:10.1186\/1752-1947-8-453"},{"issue":"18","key":"bib2","series-title":"Spine (Phila Pa 1976)","first-page":"2021","article-title":"Radiographic markers in spondyloptosis: implications for spondylolisthesis progression","volume":"27","author":"Curylo","year":"2002","unstructured":"Curylo LJEdwards CDeWald RW.Radiographic markers in spondyloptosis: implications for spondylolisthesis progression. Spine (Phila Pa 1976). 2002;27(18):2021-2025. doi:10.1097\/00007632-200209150-00010"},{"issue":"3","key":"bib3","series-title":"Cureus","first-page":"e36457","article-title":"Acute traumatic spondyloptosis: a case report","volume":"15","author":"Braithwaite","year":"2023","unstructured":"Braithwaite JGruber JFakhoury JKatsigiorigis GGrewal K.Acute traumatic spondyloptosis: a case report. Cureus. 2023;15(3):e36457. doi:10.7759\/cureus.36457"},{"issue":"2","key":"bib4","series-title":"Oper Neurosurg","first-page":"e84","article-title":"Sacral pedicle subtraction osteotomy for treatment of high-grade spondylolisthesis: a technical note and review of the literature","volume":"23","author":"Safaee","year":"2022","unstructured":"Safaee MMScheer JKLau DFury MDeviren VAmes CP.Sacral pedicle subtraction osteotomy for treatment of high-grade spondylolisthesis: a technical note and review of the literature. Oper Neurosurg. 2022;23(2):e84-e90. doi:10.1227\/ons.0000000000000251"},{"issue":"7","key":"bib5","series-title":"Spine (Phila Pa 1976)","first-page":"E388","article-title":"Use of supplemental short pre-contoured accessory rods and cobalt chrome alloy posterior rods reduces primary rod strain and range of motion across the pedicle subtraction osteotomy level: an in vitro biomechanical study","volume":"41","author":"Hallager","year":"2016","unstructured":"Hallager DWGehrchen MDahl BUse of supplemental short pre-contoured accessory rods and cobalt chrome alloy posterior rods reduces primary rod strain and range of motion across the pedicle subtraction osteotomy level: an in vitro biomechanical study. Spine (Phila Pa 1976). 2016;41(7):E388-E395. doi:10.1097\/BRS.0000000000001282"},{"issue":"9","key":"bib6","series-title":"Eur Spine J","first-page":"2198","article-title":"Supplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study","volume":"28","author":"Berjano","year":"2019","unstructured":"Berjano PXu MDamilano MSupplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study. Eur Spine J. 2019;28(9):2198-2207. doi:10.1007\/s00586-019-06012-2"},{"issue":"1","key":"bib7","series-title":"Global Spine J","first-page":"59","article-title":"Traumatic lumbosacral spondyloptosis: a case report and review of the literature","volume":"4","author":"Akesen","year":"2014","unstructured":"Akesen BMutlu MKara KAyd\u0131nl\u0131 U.Traumatic lumbosacral spondyloptosis: a case report and review of the literature. Global Spine J. 2014;4(1):59-62. doi:10.1055\/s-0033-1357082"},{"issue":"5","key":"bib8","series-title":"Spine (Phila Pa 1976)","first-page":"445","article-title":"Scoliosis in young men with spondylolysis or spondylolisthesis. a comparative study in symptomatic and asymptomatic subjects","volume":"9","author":"Libson","year":"1984","unstructured":"Libson EBloom RAShapiro Y.Scoliosis in young men with spondylolysis or spondylolisthesis. a comparative study in symptomatic and asymptomatic subjects. Spine (Phila Pa 1976). 1984;9(5):445-447. doi:10.1097\/00007632-198407000-00003"},{"issue":"1","key":"bib9","series-title":"BMC Musculoskelet Disord","first-page":"335","article-title":"Scoliosis in dysplastic spondylolisthesis: a clinical survey of 50 young patients","volume":"23","author":"Guo","year":"2022","unstructured":"Guo XGuo ZLi WScoliosis in dysplastic spondylolisthesis: a clinical survey of 50 young patients. BMC Musculoskelet Disord. 2022;23(1):335. doi:10.1186\/s12891-022-05297-7"},{"issue":"suppl 2","key":"bib10","series-title":"Eur Spine J","first-page":"S172","article-title":"AIS and spondylolisthesis","volume":"22","author":"Crostelli","year":"2013","unstructured":"Crostelli MMazza O.AIS and spondylolisthesis. Eur Spine J. 2013;22(suppl 2):S172-S184. doi:10.1007\/s00586-012-2326-8"},{"issue":"3","key":"bib11","series-title":"Int J Spine Surg","first-page":"399","article-title":"Long-term experience with reduction technique in high-grade spondylolisthesis in the young","volume":"12","author":"Sudarshan","year":"2018","unstructured":"Sudarshan PKSuthar HRVarma VKKrishnan AHegde SK.Long-term experience with reduction technique in high-grade spondylolisthesis in the young. Int J Spine Surg. 2018;12(3):399-407. doi:10.14444\/5047"},{"issue":"10","key":"bib12","series-title":"Eur Spine J","first-page":"3027","article-title":"The management of high-grade spondylolisthesis and co-existent late-onset idiopathic scoliosis","volume":"25","author":"Srivastava","year":"2016","unstructured":"Srivastava ABayley EBoszczyk BM.The management of high-grade spondylolisthesis and co-existent late-onset idiopathic scoliosis. 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