{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:55:24Z","timestamp":1790729724733,"version":"4.1.0"},"reference-count":9,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"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":[[2026,9,28]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Overcorrection of lumbar lordosis (LL) during deformity surgery can create iatrogenic hyperlordosis with negative sagittal balance, a rare but disabling complication with no standard treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 21-year-old woman with adolescent idiopathic scoliosis had undergone T3\u2013L5 fusion, revision L4\u20135 transforaminal lumbar interbody fusion (TLIF) with carbon fiber instrumentation due to a nickel allergy, and L4\u2013S1 anterior lumbar interbody fusion with L3\u2013pelvis fusion for pseudarthrosis. She developed severe low back and bilateral groin pain that worsened with standing. Imaging demonstrated exaggerated LL (L1\u2013S1 82\u00b0 vs pelvic incidence 52\u00b0), a negative sagittal vertical axis (\u201396 mm), and a PI-LL mismatch of \u201330\u00b0, consistent with global sagittal imbalance and hip impingement. She underwent revision L1\u2013S1 fusion with bilateral iliac fixation, reverse pedicle subtraction osteotomy (PSO) at L4, and L3\u20134 TLIF. Postoperatively, LL decreased to 60\u00b0 with more physiological segmental distribution and sagittal parameters improved toward neutral, with resolution of her symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Iatrogenic lumbar hyperlordosis with negative sagittal balance can cause debilitating spinopelvic mismatch. Careful attention to patient-specific spinopelvic targets is essential during deformity correction, and reverse PSO is a useful strategy to reduce fixed hyperlordosis, restore alignment, and alleviate symptoms.<\/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\/CASE25944\">https:\/\/thejns.org\/doi\/10.3171\/CASE25944<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25944","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:05:00Z","timestamp":1790121900000},"source":"Crossref","is-referenced-by-count":0,"title":["Reverse pedicle subtraction osteotomy for iatrogenic hyperlordosis in a scoliosis patient: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0546-5566","authenticated-orcid":true,"given":"Mihir S.","family":"Dekhne","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory S.","family":"Kazarian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9451-4103","authenticated-orcid":true,"given":"Stephane","family":"Owusu-Sarpong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7482-6994","authenticated-orcid":true,"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"7","key":"bib1","series-title":"Global Spine J","first-page":"1924","article-title":"How good are surgeons at achieving their preoperative goal sagittal alignment following adult deformity surgery?","volume":"14","author":"Smith","year":"2024","unstructured":"Smith JSElias ESursal THow good are surgeons at achieving their preoperative goal sagittal alignment following adult deformity surgery? Global Spine J. 2024;14(7):1924-1936. doi:10.1177\/21925682231161304"},{"issue":"18","key":"bib2","series-title":"Spine (Phila Pa 1976)","first-page":"2024","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"Glassman","year":"2005","unstructured":"Glassman SDBridwell KDimar JRHorton WBerven SSchwab F.The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976). 2005;30(18):2024-2029. doi:10.1097\/01.brs.0000179086.30449.96"},{"issue":"25","key":"bib3","series-title":"Spine (Phila Pa 1976)","first-page":"2224","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","year":"2010","unstructured":"Schwab FPatel AUngar BFarcy JPLafage 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). 2010;35(25):2224-2231. doi:10.1097\/BRS.0b013e3181ee6bd4"},{"issue":"3","key":"bib4","series-title":"J Bone Joint Surg Am","first-page":"454","article-title":"Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance","volume":"85","author":"Bridwell","year":"2003","unstructured":"Bridwell KHLewis SJLenke LGBaldus CBlanke K.Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am. 2003;85(3):454-463. doi:10.2106\/00004623-200303000-00009"},{"issue":"7","key":"bib5","series-title":"Orthop Traumatol Surg Res","first-page":"102657","article-title":"Rationale and techniques for posterior opening wedge osteotomy (POWO) in proximal junctional failure due to iatrogenic lumbar hyperlordosis","volume":"107","author":"Faundez","year":"2021","unstructured":"Faundez AATsoupras ALe Huec JC.Rationale and techniques for posterior opening wedge osteotomy (POWO) in proximal junctional failure due to iatrogenic lumbar hyperlordosis. Orthop Traumatol Surg Res. 2021;107(7):102657. doi:10.1016\/j.otsr.2020.04.015"},{"issue":"15","key":"bib6","series-title":"Spine (Phila Pa 1976)","first-page":"E721","article-title":"Technique of Reverse Smith Petersen Osteotomy (RSPO) in a patient with fixed lumbar hyperlordosis and negative sagittal imbalance","volume":"35","author":"Lewis","year":"2010","unstructured":"Lewis SJGray RDavid KKopka MMagana S.Technique of Reverse Smith Petersen Osteotomy (RSPO) in a patient with fixed lumbar hyperlordosis and negative sagittal imbalance. Spine (Phila Pa 1976). 2010;35(15):E721-E725. doi:10.1097\/BRS.0b013e3181d260a0"},{"issue":"9","key":"bib7","series-title":"Eur Spine J","first-page":"1889","article-title":"Sagittal balance of the spine","volume":"28","author":"Le Huec","year":"2019","unstructured":"Le Huec JCThompson WMohsinaly YBarrey CFaundez A.Sagittal balance of the spine. Eur Spine J. 2019;28(9):1889-1905. doi:10.1007\/s00586-019-06083-1"},{"issue":"2","key":"bib8","series-title":"Global Spine J","first-page":"149","article-title":"Negative sagittal balance following adult spinal deformity surgery","volume":"8","author":"Merrill","year":"2018","unstructured":"Merrill RKKim JSMcNeill ITNegative sagittal balance following adult spinal deformity surgery. Global Spine J. 2018;8(2):149-155. doi:10.1177\/2192568217699187"},{"issue":"1","key":"bib9","series-title":"World J Orthop","first-page":"19","article-title":"Access related complications during anterior exposure of the lumbar spine","volume":"4","author":"Fantini","year":"2013","unstructured":"Fantini GAPawar AY.Access related complications during anterior exposure of the lumbar spine. 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