Correction of vertebral pseudoarticulation: An unusual driver of adult sagittal and coronal plane deformity

Pathology of the uppermost instrumented vertebra is a recognized complication of spinal fusion. It can manifest as PJK or progress to PJF, in which kyphosis is accompanied by structural or instrument failure with symptoms requiring surgical revision. Presentation is variable, and reoperation requires an individualized approach. This case demonstrates the challenges inherent to adult spinal deformity surgery.