This 71+5-year-old female had prior low lumbar spinal surgery with fusion and a progressive spinal decompensation to the right side and forward over time. She underwent a first stage posterior reconstruction with a midlumbar PSO to realign her spine in both the coronal and sagittal planes. She then underwent a second stage anterior spinal fusion with cages placed at multiple levels of the lumbar spine. At 13 years postoperative, she has maintained excellent coronal and sagittal alignment with minimal symptoms.