Procedure: anterior L45, L5S1 ALIF instrumentation and fusion, then posterior Smith Peterson osteotomies w extension instrumentation and fusion down to ilium.

Surgical time:  90 minutes anterior, then 5 hour ad 10 min posterior.

Lordosis flat back correction: excellent.
EBL: 2100 cc.
Blood transfused: none.

This technique is nice alternative to pedicle subtraction osteotomy (PSO) when Harrington rod or other instrumentation fusion patients have adjacent level degeneration and failure w loss of disc height, pain, and kyphotic posture.

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
https://www.heyclinic.com