Different Concepts in Short Segment Reconstruction of Moderate to Severe PI-LL Mismatch Deformity with ALIF, Mini-PSO, and TLIF

Sagittal plane deformities of the thoracolumbar spine, in which there is a significant mismatch between pelvic incidence (PI) and lumbar lordosis (LL) can negatively impact quality of life. Reconstructive surgery frequently involves long-segment spinal fusion. This video case series presents 3 patients with moderate to severe PI-LL mismatch spinal deformities, who underwent short construct corrections using varying strategies. Case 1 utilizes a combination of posterior column osteotomy (PCO) and anterior lumbar interbody fusion (ALIF) to achieve correction. Case 2 describes a combined transforaminal lumbar interbody fusion (TLIF) with a partial pedicle subtraction osteotomy (PSO). Lastly, case 3 details deformity correction with a multilevel TLIF, using extra-large footprint static banana cages, combined with posterior column osteotomy. The aim of this video case series is to outline these 3 techniques and illustrate that in select cases, a short-segment fusion limited to the lumbar spine can achieve significant deformity correction.