Fig. 5.

A 61-year-old male who has severe sagittal imbalance of 27 cm and fixed hip contracture of 20 degree despite prior spinal instrumentation and fusion surgeries. Revision PSSIF at T9–Pelvis with 2 PLIFs at L3–4/L4–5 and PSO at L3 showed good restoration of lumbar lordosis from 0.70 to 49.20. His preoperative PI was 42 degree. However, his SVA in 2 months is 12.2 cm. Increase in thoracic kyphosis of 130 and sacral slope of 140 took out the advantage of good restoration of lumbar lordosis of 480. Better sagittal vertical axis is expected in the future if flexion contracture of the hip is relieved with physical therapy. SVA : sagittal vertical axis, PI : pelvic incidence, SS : sacral slope, LL : lumbar lordosis, TK : thoracic kyphosis, PO : postoperative, PSSIF : posterior spinal segmental instrumentation and fusion, PLIF : posterior lumbar interbody fusion, PSO : pedicle subtraction osteotomy.