Adult Idiopathic Scoliosis Case 13

Case Review #13: 50 year old female with progressive Adult Idiopathic Scoliosis from Robert Pashman

A 50 year old female presented with a progressive 58° thoracic curve, and 60° lumbar curve. No previous surgeries. KIM/SRP Classification 3

    Case Review:

    Adult Idiopathic Scoliosis with progressive 58° thoracic curve and 60° lumbar curve.

    Patient History:

    50-year-old female, diagnosed with Adult Idiopathic Scoliosis, no previous surgeries.
    No non idiopathic history such as neuromuscular problems or structural abnormalities including congenital abnormalities of her spine.
    The patient is otherwise in good health, having quit smoking approximately 8 years ago.
    The scoliosis and progressive deformity are associated with significant pain that related to her right flank where the curve is of its largest magnitude, and the patient is also having neck, thoracic and low back pain, and radiculopathy, which is currently being managed by escalating amounts of narcotics.
    Her shoulders are level. She has a right rib hump, left flank fullness associated with a significant flank crease on concave right side.
    Pelvis seems to be level. Leg lengths are equal and neurologically she is intact. She is well-balanced in the frontal and sagittal planes and looks otherwise healthy

    Pre-op X-rays:

    The patient has a 58° upper thoracic, 60° lumbar curve with significant rotation. She has significant fractional lumbosacral obliquity but otherwise is well-balanced in the frontal and sagittal plane. The patients symptoms will definitely be progressive over the long term. We know that statistically because adults with curves greater than progress at approximately 1° per year.

    Indications for Surgery:

    Adult progressive idiopathic scoliosis, 60° lumbar progression with compensatory thoracic curve.
    Lumbosacral anomaly with significant lumbosacral obliquity.
    Stenosis of foramen with low back pain.Failed conservative therapy.
    Low back pain and radicular symptoms.

    Surgical Strategy:

    Posterior spinal instrumented fusion using pedicle screw rod construct from T3 to sacral pelvis, 5.5 stainless steel.
    Spinal osteotomy Smith-Petersen and a Ponte osteotomy, T5-6, T6-7, T7-8, T8-9, T9-10, T10-11, T12-L1, L1-2, L3-4, L4-5, L5-S1, 11-level, for mobilization of rigid spinal deformity.
    Interlaminar decompression for concave stenosis L2-3, L3-4, L4-5,L5-S1 under loupe and headlight magnification.
    Interlaminar laminotomies with facetectomy lateral recess release onthe left-hand side at L3-4, L4-5, L5-S1.Posterior spinal fusion with locally harvested autogenous bone and rhBMP T3 to sacral pelvis.
    Motor evoked potentials.
    Intraoperative fluoroscopy.

    Post-Op Films:

    The patient is balanced in both the frontal and sagittal planes.

    Pre-Op/Post-op Comparison:

    The patient’s curvature was reduced by 50%, from 60° to 30°. She gained several inches in height, and was very happy with the outcome of her surgery.
    The patient is balanced in the sagittal plane, and no longer has symptoms in her legs.

Related links:

Scoliosis overview
Adult Idiopathic Scoliosis
Patient journal of scoliosis surgery, Patient follow-up journal four years after surgery
Scoliosis FAQ’s
Books about Scoliosis