Technique of Reverse Smith Petersen Osteotomy (RSPO) in a Patient With Fixed Lumbar Hyperlordosis and Negative Sagittal Imbalance

Study Design. Case report. Objective. To determine the viability and safety of Reverse Smith Petersen Osteotomy (RSPO) to re-established sagittal balance in patients with fixed lumbar hyperlordosis. Summary and Background Data. Lumbar hyperlordosis is seen as a compensatory mechanism in thoracic Scheuermann disease and in sagittal decompensation in severe neuromuscular scoliosis. Hyperlordosis may also be seen after overcorrection with spinal osteotomies, but rarely causes clinically significant negative sagittal imbalance because of the thoracic compensation. We describe a case using a kyphosing osteotomy to treat hyperlordosis in a patient that was treated with a pedicle subtraction osteotomy for post-Harrington kyphosis. Methods. The radiographs and clinical chart were reviewed of a patient treated with a RSPO at L2-L3 to correct the negative sagittal imbalance created by a previous extension of her fusion to the sacrum with a pedicle subtraction osteotomy. Results. A reduction in the lumbar lordosis by 20 at L2-L3 and restoration of the global sagittal balance was achieved with the RSPO. Conclusion. RSPO is a viable surgical technique that can be used to re-establish sagittal balance in patients with fixed lumbar hyperlordosis. Appreciation of a patient's balanced sagittal alignment and available compensatory mechanisms can help ensure appropriate osteotomies are performed.