Treatment of spinal stenosis and fixed sagittal imbalance.

Most commonly, sagittal imbalance associated with stenosis is seen with a hypolordotic fusion mass, junctional kyphosis, and junctional stenosis. If the deformity is flexible, it can be treated with anterior and posterior fusion with anterior structural grafting. If it is fixed, which it usually is, then a pedicle subtraction procedure with decompression and extension of the fusion usually is the most suitable operative approach.