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J Korean Soc Spine Surg. 2009 Jun;16(2):142-151. Korean. Case Report.
Kim KT , Lee JH .
Department of Orthopaedic Surgery, School of Medicine, Kung-Hee University, Seoul, Korea.

Sagittal spinal balance is an essential factor for not only the external appearance, but also for the spine's function. Fixed sagittal imbalance is the result of different causes, and this generally requires surgical treatment. Sagittal imbalance is mainly caused by decreased lumbar lordosis and increased thoracic kyphosis, and it can also be influenced by the pelvic incidence and flexion contracture of the hip and knee joints. So, a careful understanding and clinically considering the many factors and compensatory mechanisms that are associated with sagittal imbalance are needed. Proper surgical treatments provide a satisfactory outcome for these patients and good radiographic results. Correction of sagittal imbalance generally requires spinal osteotomy and long segment fusion. For the surgical treatment, we should consider the perioperative and postoperative complications of osteotomy and long segment fusion and then make proper decisions for the range of fusion of the proximal and distal sides and the selection of the correct method of osteotomy, the ideal correction angle and the best method of internal fixation. Problems such as loss of correction may occur postoperatively due to kyphotic change and pseudarthrosis of the proximal and distal sides. Therefore, we need to conduct a thorough analysis and make a detailed plan for the surgical approach. We should also study and understand the radiological factors when treating sagittal spinal balance because not only the spine, but also the pelvis, hip and knee joints are involved in forming the sagittal balance

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