{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:02Z","timestamp":1776096362298,"version":"3.50.1"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"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":[[2026,3,16]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Patients with adjacent segment degeneration after previous lumbar fusion often present with flat back posture. However, it is sometimes unclear if the flat back results from stenosis above the fusion or from structural spinal deformity. The authors illustrate the case of a patient who refused further fusion and asked for decompression only coupled with posterior arthroplasty. They demonstrate his change in sagittal alignment despite absence of a three-column osteotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 72-year-old man with a previous lumbar fusion presented with 1 year of progressive neurogenic claudication and radiculopathy. Imaging revealed flat back syndrome with positive sagittal balance and adjacent segment disease with severe stenosis at L2\u20133. The patient was recommended to undergo a three-column osteotomy, but he refused another fusion surgery. He requested decompression and posterior arthroplasty at L2\u20133, with the understanding that his flat back syndrome would not be treated. Following surgery, the patient\u2019s preoperative symptoms improved, and, surprisingly, postoperative radiographs revealed a 6.7-cm improvement in sagittal balance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Alleviation of lumbar stenosis not only provided symptomatic relief but also improved this patient\u2019s sagittal imbalance, illustrating the contribution of lumbar stenosis to sagittal imbalance. Laminectomy with total factectomies was facilitated by the posterior arthroplasty device, which prevented pathological motion despite the destabilizing decompressive procedure.<\/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\/CASE25565\">https:\/\/thejns.org\/doi\/10.3171\/CASE25565<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25565","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:13:05Z","timestamp":1773925985000},"source":"Crossref","is-referenced-by-count":0,"title":["Improvement in spinopelvic parameters after laminectomy and complete factectomies above prior fusion facilitated by posterior arthroplasty: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Andr\u00e9s","family":"Pascual-Leone","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7243-8779","authenticated-orcid":true,"given":"Evan F.","family":"Joiner","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farhan","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Agopyan-Miu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"15","key":"bib1","series-title":"Spine (Phila Pa 1976)","first-page":"E519","article-title":"Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis?","volume":"34","author":"Mac-Thiong","year":"2009","unstructured":"Mac-Thiong JMTransfeldt EEMehbod AACan c7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976). 2009;34(15):E519-E527. doi:10.1097\/BRS.0b013e3181a9c7ad"},{"issue":"9","key":"bib2","series-title":"Spine (Phila Pa 1976)","first-page":"E344","article-title":"Total sagittal spinal alignment in patients with lumbar canal stenosis accompanied by intermittent claudication","volume":"35","author":"Suzuki","year":"2010","unstructured":"Suzuki HEndo KKobayashi HTanaka HYamamoto K.Total sagittal spinal alignment in patients with lumbar canal stenosis accompanied by intermittent claudication. Spine (Phila Pa 1976). 2010;35(9):E344-E346. doi:10.1097\/BRS.0b013e3181c91121"},{"issue":"2","key":"bib3","series-title":"Neurosurg Clin N Am","first-page":"157","article-title":"Sagittal spinal pelvic alignment","volume":"24","author":"Klineberg","year":"2013","unstructured":"Klineberg ESchwab FSmith JSGupta MCLafage VBess S.Sagittal spinal pelvic alignment. Neurosurg Clin N Am. 2013;24(2):157-162. doi:10.1016\/j.nec.2012.12.003"},{"issue":"6","key":"bib4","series-title":"Spine (Phila Pa 1976)","first-page":"682","article-title":"Correlation of radiographic parameters and clinical symptoms in adult scoliosis","volume":"30","author":"Glassman","year":"2005","unstructured":"Glassman SDBerven SBridwell KHorton WDimar JR.Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005;30(6):682-688. doi:10.1097\/01.brs.0000155425.04536.f7"},{"issue":"6","key":"bib5","series-title":"Neurosurg Rev","first-page":"3739","article-title":"Decompression with or without fusion in degenerative adjacent segment stenosis after lumbar fusions","volume":"45","author":"Fr\u00fch","year":"2022","unstructured":"Fr\u00fch ALei\u00dfa PTkatschenko DDecompression with or without fusion in degenerative adjacent segment stenosis after lumbar fusions. Neurosurg Rev. 2022;45(6):3739-3748. doi:10.1007\/s10143-022-01875-4"},{"issue":"24","key":"bib6","series-title":"Spine (Phila Pa 1976)","first-page":"2790","article-title":"Biomechanical evaluation of a new total posterior-element replacement system","volume":"31","author":"Wilke","year":"2006","unstructured":"Wilke HJSchmidt HWerner KSchm\u00f6lz WDrumm J.Biomechanical evaluation of a new total posterior-element replacement system. Spine (Phila Pa 1976). 2006;31(24):2790-2797. doi:10.1097\/01.brs.0000245872.45554.c0"},{"issue":"12","key":"bib7","series-title":"Cureus","first-page":"e12361","article-title":"Total posterior spinal arthroplasty systems for dynamic stability","volume":"12","author":"Fiani","year":"2020","unstructured":"Fiani BNoblett CChacon DSiddiqi IPennington EKortz M.Total posterior spinal arthroplasty systems for dynamic stability. 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Diagnostics (Basel). 2024;14(21):2380. doi:10.3390\/diagnostics14212380"},{"key":"bib9","series-title":"World Neurosurg","first-page":"e417","article-title":"Improvement in sagittal balance after decompression surgery without fusion in patients with degenerative lumbar stenosis: clinical and radiographic results at 1 year","volume":"114","author":"Madkouri","year":"2018","unstructured":"Madkouri RBrauge DVidon-Buthion AImprovement in sagittal balance after decompression surgery without fusion in patients with degenerative lumbar stenosis: clinical and radiographic results at 1 year. World Neurosurg. 2018;114:e417-e424. doi:10.1016\/j.wneu.2018.03.002"},{"issue":"6","key":"bib10","series-title":"Asian Spine J","first-page":"1089","article-title":"Correction of spinal sagittal alignment after posterior lumbar decompression: does severity of central canal stenosis matter?","volume":"17","author":"Trenchfield","year":"2023","unstructured":"Trenchfield DLee YLambrechts MCorrection of spinal sagittal alignment after posterior lumbar decompression: does severity of central canal stenosis matter? 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Neurosurg Focus. 2007;22(1):E13. doi:10.3171\/foc.2007.22.1.13"},{"issue":"1","key":"bib19","series-title":"J Health Econ Outcomes Res","first-page":"82","article-title":"A prospective study of lumbar facet arthroplasty in the treatment of degenerative spondylolisthesis and stenosis: early cost-effective assessment from the total posterior spine system (TOPS\u2122) IDE study","volume":"9","author":"Ament","year":"2022","unstructured":"Ament JDVokshoor ABadr YLanman TKim KDJohnson JP.A prospective study of lumbar facet arthroplasty in the treatment of degenerative spondylolisthesis and stenosis: early cost-effective assessment from the total posterior spine system (TOPS\u2122) IDE study. 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Oper Neurosurg. 2022;23(1):14-21. doi:10.1227\/ons.0000000000000226"},{"issue":"2","key":"bib23","series-title":"Clin Spine Surg","first-page":"E59","article-title":"A prospective study of lumbar facet arthroplasty in the treatment of degenerative spondylolisthesis and stenosis: results from the total posterior spine system (TOPS) IDE study","volume":"36","author":"Pinter","year":"2023","unstructured":"Pinter ZWFreedman BANassr AA prospective study of lumbar facet arthroplasty in the treatment of degenerative spondylolisthesis and stenosis: results from the total posterior spine system (TOPS) IDE study. Clin Spine Surg. 2023;36(2):E59-E69. doi:10.1097\/BSD.0000000000001365"},{"issue":"1","key":"bib24","series-title":"J Neurosurg Spine","first-page":"36","article-title":"Long-term results for total lumbar facet joint replacement in the management of lumbar degenerative spondylolisthesis","volume":"32","author":"Smorgick","year":"2020","unstructured":"Smorgick YMirovsky YFloman YRand NMillgram MAnekstein Y.Long-term results for total lumbar facet joint replacement in the management of lumbar degenerative spondylolisthesis. J Neurosurg Spine. 2020;32(1):36-41. doi:10.3171\/2019.7.SPINE19150"},{"issue":"12","key":"bib25","series-title":"J Bone Joint Surg Am","first-page":"1041","article-title":"Lumbar facet arthroplasty versus fusion for Grade-I degenerative spondylolisthesis with stenosis: a prospective randomized controlled trial","volume":"106","author":"Nassr","year":"2024","unstructured":"Nassr ACoric DPinter ZWLumbar facet arthroplasty versus fusion for Grade-I degenerative spondylolisthesis with stenosis: a prospective randomized controlled trial. 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Spine (Phila Pa 1976). 2010;35(9):E344-E346. doi:10.1097\/BRS.0b013e3181c91121"},{"issue":"2","key":"bib3","series-title":"Neurosurg Clin N Am","first-page":"157","article-title":"Sagittal spinal pelvic alignment","volume":"24","author":"Klineberg","year":"2013","unstructured":"Klineberg ESchwab FSmith JSGupta MCLafage VBess S.Sagittal spinal pelvic alignment. Neurosurg Clin N Am. 2013;24(2):157-162. doi:10.1016\/j.nec.2012.12.003"},{"issue":"6","key":"bib4","series-title":"Spine (Phila Pa 1976)","first-page":"682","article-title":"Correlation of radiographic parameters and clinical symptoms in adult scoliosis","volume":"30","author":"Glassman","year":"2005","unstructured":"Glassman SDBerven SBridwell KHorton WDimar JR.Correlation of radiographic parameters and clinical symptoms in adult scoliosis. 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World Neurosurg. 2018;114:e417-e424. doi:10.1016\/j.wneu.2018.03.002"},{"issue":"6","key":"bib10","series-title":"Asian Spine J","first-page":"1089","article-title":"Correction of spinal sagittal alignment after posterior lumbar decompression: does severity of central canal stenosis matter?","volume":"17","author":"Trenchfield","year":"2023","unstructured":"Trenchfield DLee YLambrechts MCorrection of spinal sagittal alignment after posterior lumbar decompression: does severity of central canal stenosis matter? 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Spine (Phila Pa 1976). 2018;43(6):388-393. doi:10.1097\/BRS.0000000000002435"},{"issue":"3","key":"bib17","series-title":"J Neurosurg Spine","first-page":"390","article-title":"Long-term benefits of appropriately corrected sagittal alignment in reconstructive surgery for adult spinal deformity: evaluation of clinical outcomes and mechanical failures","volume":"34","author":"Lee","year":"2021","unstructured":"Lee CSPark JSNam YChoi YTPark SJ.Long-term benefits of appropriately corrected sagittal alignment in reconstructive surgery for adult spinal deformity: evaluation of clinical outcomes and mechanical failures. J Neurosurg Spine. 2021;34(3):390-398. doi:10.3171\/2020.7.SPINE201108"},{"issue":"1","key":"bib18","series-title":"Neurosurg Focus","first-page":"E13","article-title":"Treatment of lumbar spinal stenosis with a total posterior arthroplasty prosthesis: implant description, surgical technique, and a prospective report on 29 patients","volume":"22","author":"McAfee","year":"2007","unstructured":"McAfee PKhoo LTPimenta LTreatment of lumbar spinal stenosis with a total posterior arthroplasty prosthesis: implant description, surgical technique, and a prospective report on 29 patients. Neurosurg Focus. 2007;22(1):E13. doi:10.3171\/foc.2007.22.1.13"},{"issue":"1","key":"bib19","series-title":"J Health Econ Outcomes Res","first-page":"82","article-title":"A prospective study of lumbar facet arthroplasty in the treatment of degenerative spondylolisthesis and stenosis: early cost-effective assessment from the total posterior spine system (TOPS\u2122) IDE study","volume":"9","author":"Ament","year":"2022","unstructured":"Ament JDVokshoor ABadr YLanman TKim KDJohnson JP.A prospective study of lumbar facet arthroplasty in the treatment of degenerative spondylolisthesis and stenosis: early cost-effective assessment from the total posterior spine system (TOPS\u2122) IDE study. J Health Econ Outcomes Res. 2022;9(1):82-89. doi:10.36469\/001c.33035"},{"issue":"10","key":"bib20","series-title":"Eur Spine J","first-page":"2306","article-title":"Seven years follow-up for total lumbar facet joint replacement (TOPS) in the management of lumbar spinal stenosis and degenerative spondylolisthesis","volume":"24","author":"Anekstein","year":"2015","unstructured":"Anekstein YFloman YSmorgick YRand NMillgram MMirovsky Y.Seven years follow-up for total lumbar facet joint replacement (TOPS) in the management of lumbar spinal stenosis and degenerative spondylolisthesis. 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