Application of full-balance-integrated technique in asymmetrical pedicle subtraction osteotomy for treating fixed degenerative lumbar kyphoscoliosis

SummaryA 56-year-old female patient experienced mild back pain, which radiated to her legs, as well as intermittent claudication for 5 years. The symptoms became more pronounced on sitting and walking, and conservative therapy was ineffective in relieving pain. Preoperative whole-spine X-ray scans revealed degenerative lumbar kyphoscoliosis. Asymmetrical pedicle subtraction osteotomy was performed and a convex-sided posterolateral wedge osteotomy was applied to correct the scoliosis and restore sagittal balance. Pre- and postoperative sagittal balance was measured using a C7 plumb line for both scans, and the difference was calculated. Lumbar scoliosis was measured using the Cobb angle. The degree of correction required to restore sagittal alignment was 25°, which was determined on the basis of the full-balance-integrated technique. The operative time and blood loss were 365 minutes and 1620 mL, respectively. Postoperatively, the lumbar scoliosis decreased from 10.2° to 2.0°, and the sagittal vertical axis decreased from 7.6 cm to 3.3 cm. The visual analog scale and Oswestry disability index scores indicated that the patient was relieved of the symptoms after the surgery. No complications were observed during the follow-up period.