Adult Idiopathic Scoliosis with Spondylolisthesis Case Review: Case 2

Case Review #2: 41 year old female presented with Adult Scoliosis and Spodylolisthesis from Robert Pashman

A 41 year old female with a 50° thoracolumbar curve and Spondylolisthesis. Dr. Pashman treated the patient with an Posterior Spinal Fusion from T10-Pelvis. Her curve was a KIM/SRP Classification 2.

    Case Review:

    Adult Idiopathic Scoliosis with Spondylolisthesis

    Patient History:

    41 year old female
    Severe low back pain
    Severe leg pain
    Conservative therapy improved symptoms for a short time frame

    Indications for Surgery:

    1. Adult idiopathic scoliosis lumbar spine 51º left curve.
    2. Isthmic spondylolisthesis grade 2, L5-S1.
    3. Failed conservative therapy.
    4. Progressive deformity in both the frontal and sagittal plane with progressive scoliosis.

    Surgical Strategy:

    Segment spinal instrumentation with pedicle screw rod construct, thoracic 10 to sacral pelvis. This is ten levels to correct a 50º lumbar curve.
    Micro lateral recess decompression L1-2, L2-3, L3-4, L4-5, L5-S1 on the left; and L4-5 and L5-S1 on the right for spondylolisthesis.
    Posterior spinal fusion using autogenous bone T10 to sacral pelvis
    Right iliac crest exposure for the placement of pelvic fixation.
    Spinal osteotomy with removal of facets which are ankylosed for mobilization of lumbar curve L1-2, L2-3, L3-4 bilaterally.
    Partial laminectomy for removal ligamentum flavum and mobilization and lordosis spinal deformity L1-2, L2-3, L3-4, L4-5
    Anterior interbody fusion, L5-S1 using a PEEK 12 mm implant with rhBMP.
    Anterior screw fixation, L5-S1.
    Reduction spondylolisthesis, Anterior interbody fusion with a 12 mm PEEK graft with rhBMP at L4-5.

    Post Operative X-rays:

    Reconstruction included the whole curve, and the isthmic spondylolisthesis with extra fixation including iliac fixation because of the high instabilities and of the long lever arm.

    X-ray Comparison:

    The patient is doing well. She is balanced in both the sagittal and coronal planes.

    Post-op X-rays:

    The patient doing quite well. No radiculopathy, low back pain, or GI problems. X-rays show excellent sagittal balance and good placement of the instrumentation.

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