60+3-year-old female with several failed lumbar spine surgeries who presented with a severe forward truncal imbalance, such that the only way she could maintain an upright posture was to hold on to a wheelchair or walker. She underwent a two stage spinal reconstruction consisting of a long instrumentation and fusion from the upper thoracic spine all the way to her pelvis, with a midlumbar PSO to reshape her lumbar spine into more normal lordosis to allow her to stand upright. The second stage consisted of an anterior fusion/cage surgery to make sure she healed in that good position. At 7 years postoperative, she has maintained excellent clinical alignment and balance.