This case report describes a 66-year old woman with Parkinson´s disease and a subacute onset lateral postural deformity. She experienced severe back pain and reduced walking ability. She was diagnosed with Pisa syndrome and sagittal and coronal imbalance was observed on radiographs. Posterior reconstructive surgery was performed from sacrum to Th10. Post operatively, sagittal and coronal imbalance was improved and maintained at the two year follow-up. The patient remained pain free and improvements in walking ability were sustained. The caveats of spine surgery in Parkinson´s patients are discussed and the importance of goal oriented surgery in terms of improvements in sagittal and coronal balance.

Fig Ib and Ic Standing radiographs show the extent of the postural deformity in the coronal and sagittal plane.

Fig II Cage was inserted at the L4-L5 interval to achieve correction of the deformity.

Fig III Standing postoperative photograph showing good clinical correction at the two year follow-up

Fig IVa and IVb Standing radiographs at the two follow-up show sustained correction of the deformity.