• Marcin Czyz, Stephen Forster, James Holton, Babak Shariati, David J Clarkson, and Bronek M Boszczyk.
• The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, D Floor, West Block, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
• Eur Spine J. 2017 Aug 1; 26 (8): 2204-2210.

Study DesignTechnical note.ObjectiveWe describe a novel technique of bilateral longitudinal sacral osteotomy allowing direct reduction of high pelvic incidence (PI) and correction of sagittal imbalance.MethodsA 25-year-old female patient presented with a disabling lumbo-sacral kyphosis fused in situ through previous operations with residual low-grade wound infection and grade IV L5/S1 spondylolisthesis with severity index (SI) of 65%. A two-stage correction was performed. First anterior in situ fixation of the L4-L5-S1 segments was performed using a hollow modular anchorages (HMA) screw and L3/L4 anterior interbody cage. The second stage consisted of instrumentation of the lower lumbar spine and pelvis; placement of an S1 transverse K-wire as pivot point and bilateral longitudinal sacral osteotomy which allowed for gradual retroversion of the central sacrum relative to the pelvis.ResultsSacrum was derotated by 30° which allowed to restore spinal sagittal balance and decrease SI by 15%. Postoperative recovery was complicated by a flare up of the pre-existing deep wound infection.ConclusionsBilateral longitudinal sacral osteotomy appears to be a safe and efficient way of correcting the sagittal imbalance caused by an extremely high PI. Although technically demanding, it achieves good radiological and functional outcomes and avoids entering the spinal canal.

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