Salvage of pediatric spondyloptosis treated with sacral pedicle subtraction osteotomy: illustrative case

BACKGROUND Spondyloptosis is a rare condition with many different surgical treatment options for management. Revision surgery in these cases can be complex and challenging, with little available literature to guide approaches. The authors describe the first pediatric use of a sacral pedicle subtraction osteotomy (PSO) to salvage a revision spondyloptosis case with severe scoliosis. OBSERVATIONS A 14-year-old adolescent female presented with hyperlordotic posture and bilateral extensor hallucis longus weakness. She had an L5–S1 spondyloptosis with an 80° olisthetic scoliosis. She underwent a posterior spinal fusion from T3 to her pelvis with the Bohlman technique. Six months postoperatively, she had a broken rod treated with rod exchange and bone morphogenetic protein. Hardware failure occurred 6 months postoperatively. To address the progressive sagittal imbalance, lumbosacral kyphosis, and associated high shear stresses, a sacral PSO was performed. This osteotomy was performed proximal to the previous Bohlman dowel, which was well fused and then supplemented with a multirod construct including four rods and a kickstand rod. LESSONS This case illustrates a complex symptomatic spondyloptosis and olisthetic scoliosis. A sacral PSO, in contrast to a revision lumbar PSO, for restoration of sagittal alignment can be utilized as a surgical salvage technique with the use of the kickstand rod. https://thejns.org/doi/10.3171/CASE251020