Kyphosis and sagittal imbalance: osteotomies

Because standing upright has stopped being free. While the pelvis and the thoracic spine can compensate, the body hides the loss of curve; once that capacity is exhausted, the trunk leans forward and staying upright demands continuous muscular effort. That fatigue is a symptom, not a lack of fitness.

Removing one or more wedges of bone from the vertebra and fixing the spine again in the correct position. It is what makes it possible to recover the curve when the spine is already rigid and cannot be corrected simply by mobilising it.

Yes, it is major surgery and there is no point presenting it otherwise. What makes it safe and precise is the work done beforehand: the study that plans the degrees of correction and of compensation each segment needs. Without that study we do not go into theatre.

That is what we call post-surgical flat back, and it is one of the indications for this technique: the spine lost its curve after the fusion and the trunk no longer sits over the pelvis. It is a mechanical problem, and mechanical problems can be corrected.