Volume 83, Issue 8 (November 2025)
Tehran Univ Med J 2025, 83(8): 614-620 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Nabiouni M, Ghorbanpour Barforoshi A, Tavakoli Pirzaman A. Correction of severe kyphosis in a patient with
high pelvic incidence: a case report. Tehran Univ Med J 2025; 83 (8) :614-620
URL: http://tumj.tums.ac.ir/article-1-13804-en.html
URL: http://tumj.tums.ac.ir/article-1-13804-en.html
1- Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Abstract: (54 Views)
Background: Severe spinal kyphosis, particularly in patients with sagittal imbalance and high Pelvic incidence (PI), represents one of the most challenging conditions in spinal surgery. This deformity is commonly associated with chronic pain, functional limitation, and a decreased quality of life.
Case Presentation: A 66 year old woman presented with progressively worsening radicular pain, gait impairment, early fatigue while standing, and a severe kyphotic deformity with marked sagittal imbalance. Her history was significant for an instrumented lumbar fusion from L3 to S1 performed in March 2023, complicated by persistent right foot drop, followed approximately five weeks later by rehospitalization for herpetic encephalitis; concurrent imaging demonstrated inflammatory changes at the L5-S1 disc space suspicious for discitis, although CT guided biopsy cultures were negative. Her medical comorbidities included type 2 diabetes mellitus and prior coronary artery bypass grafting. Radiographic and spinopelvic analysis revealed adjacent segment disease at L2-L3 and severe sagittal malalignment with a pelvic incidence of 88°, lumbar lordosis of 30°, and sagittal vertical axis of 25 cm. Given the significant PI-LL mismatch and progressive postural collapse, revision deformity surgery was indicated. The patient underwent a Smith-Petersen osteotomy at L5-S1 with long segment posterior fixation from T11 to S2, including iliac screw fixation, between August and September 2025. Postoperatively, lumbar lordosis improved to 45°, pelvic incidence decreased to 65°, and global sagittal alignment was restored, resulting in marked pain relief, improved standing tolerance, correction of spinal balance, and stable neurological status during recovery.
Conclusion: Postoperatively, significant improvement in sagittal balance was achieved, with LL increasing to 45° and PI decreasing to 65°, leading to marked functional recovery and pain relief. This case powerfully demonstrates the correlation between a high Pelvic incidence (PI) and prior surgical failure. It serves as an important didactic example in understanding the biomechanical drivers of sagittal deformity, emphasizing the optimization of safer, corrective surgical techniques for high-risk, complex patients to ensure durable global alignment.
Case Presentation: A 66 year old woman presented with progressively worsening radicular pain, gait impairment, early fatigue while standing, and a severe kyphotic deformity with marked sagittal imbalance. Her history was significant for an instrumented lumbar fusion from L3 to S1 performed in March 2023, complicated by persistent right foot drop, followed approximately five weeks later by rehospitalization for herpetic encephalitis; concurrent imaging demonstrated inflammatory changes at the L5-S1 disc space suspicious for discitis, although CT guided biopsy cultures were negative. Her medical comorbidities included type 2 diabetes mellitus and prior coronary artery bypass grafting. Radiographic and spinopelvic analysis revealed adjacent segment disease at L2-L3 and severe sagittal malalignment with a pelvic incidence of 88°, lumbar lordosis of 30°, and sagittal vertical axis of 25 cm. Given the significant PI-LL mismatch and progressive postural collapse, revision deformity surgery was indicated. The patient underwent a Smith-Petersen osteotomy at L5-S1 with long segment posterior fixation from T11 to S2, including iliac screw fixation, between August and September 2025. Postoperatively, lumbar lordosis improved to 45°, pelvic incidence decreased to 65°, and global sagittal alignment was restored, resulting in marked pain relief, improved standing tolerance, correction of spinal balance, and stable neurological status during recovery.
Conclusion: Postoperatively, significant improvement in sagittal balance was achieved, with LL increasing to 45° and PI decreasing to 65°, leading to marked functional recovery and pain relief. This case powerfully demonstrates the correlation between a high Pelvic incidence (PI) and prior surgical failure. It serves as an important didactic example in understanding the biomechanical drivers of sagittal deformity, emphasizing the optimization of safer, corrective surgical techniques for high-risk, complex patients to ensure durable global alignment.
Keywords: case report, corrective spinal surgery, pelvic incidence, sagittal balance, severe kyphosis.
Type of Study: Case Report |
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
