Two-stage spinal osteotomy combined with lateral lumbar interbody fusion for lumbar kyphosis: illustrative case.

backgroundAdult spinal reconstructive surgery that requires multilevel spinal fusion is highly invasive and requires two-stage surgery using lateral lumbar interbody fusion (LLIF) and/or percutaneous pedicle screw (PPS) fixation to make it less invasive. However, it is still difficult to make spinal osteotomy less invasive, and the high complication rate is an issue. OBSERVATIONS: The authors present the surgical techniques of a two-stage Schwab grade 4 spinal osteotomy using LLIF, which could reduce surgical invasiveness and enable good correction and anterior spinal column reconstruction for lumbar kyphosis, and also report a case treated with this procedure. The first surgery consisted of L2-5 LLIF and L6-S1 posterior lumbar interbody fusion with temporary PPS fixation. The second surgery, 2 weeks after the first surgery, was a grade 4 osteotomy performed in the L4 vertebral body at a 30° angle toward the center of the LLIF cage between L3 and L4, followed by PPS fixation from T10 to the pelvis and additional fixation with two collateral rods. LESSONS: Two-stage grade 4 osteotomy using LLIF could reduce invasiveness and blood loss while providing good anterior support. This surgical method is expected to make spinal reconstruction surgeries requiring osteotomy less invasive. https://thejns.org/doi/10.3171/CASE24515.