The correction of lumbar kyphotic deformities requires careful preoperative clinical and radiographic evaluation. For patients with rigid deformities at locations where previous anterior spinal surgery was performed, pedicle subtraction osteotomy remains an attractive treatment option. This technique uses a single-stage posterior approach for removal of the posterior elements and a wedge of the vertebral body. Using this method, it is possible to introduce up to 35 degrees of lumbar lordosis and add up to 10 cm of posterior trunk translation. Patient satisfaction from correction of these deformities is frequently excellent, but a high degree of attention must be directed to avoid neural injuries and reduce intraoperative blood loss.