Degenerative Scoliosis with rotation. Treated by Robert Pashman MD with a posterior spinal fusion from T10-Pelvis: Case 24

Case Review #24: 67 year old female with Degenerative Scoliosis from Robert Pashman

67 year old female presented with DeNovo Scoliosis, with significant rotation due to Adolescent Idiopathic Scoliosis. Dr. Pashman treated the patient with a posterior spinal fusion from T10-Pelvis. KIM/SRP Classification 2.

    Case Review:

    Degenerative Scoliosis with rotation at L4-S1. Treated by Robert Pashman MD with a posterior spinal fusion from T10-Pelvis

    Patient History:

    67 year old female
    Status post intralaminar decompression on April 15, 2003, for primary complaints of radiculopathy in her right leg. Now she is having increased back pain, left pain radiating to her low back and laterally to her thigh.
    She has slight forward decompensation with gait, this due to lack of lumbar lordosis; 36 x 14 showed a collapsing degenerative scoliosis centered around L4 to S1 with significant rotation probably based on Adolescent Idiopathic Scoliosis with degenerative component.
    Low back pain especially with sitting.
    On physical examination she is decompensated in the coronal plane and has thoracolumbar kyphosis up to approximately T12.

    Indications for Surgery:

    Adult Idiopathic/Denovo Scoliosis, thoracolumbar spine. Lumbar kyphosis, status post degeneration of the lumber spine. Status post interlaminar decompression, L3-4, L4-5 and L5-S1 on the right for radiculopathy. Now with increasing low back and radicular pain due to the above diagnoses. Multiple co-morbidities including osteopenia and pain medicine.

    Surgical Strategy:

    Segmental spinal instrumentation at thoracic 10 to sacral pelvis using 1/4 inch stainless steel pedicle screw/rod construct.2.
    Multiple level Smith-Peterson osteotomy, thoracolumbar spine T12 to L3 with bilateral radical facetectomy, under the microscope.3. Interlaminar laminotomies with facetectomy, re-exploration and decompression, L3-4, L4-5, L5-S1 on the right.4. Posterior spinal fusion using locally harvested autogenous bone and RH BMP, T10 to sacral pelvis.5. Intraoperative somatosensory evoked potentials.6. Intraoperative fluoroscopy.

    Post-Op Films:

    The patient is 6 months status post posterior instrumented fusion for Kim/SRP type 2 adult idiopathic curve. The patient is doing well. She has no radiculopathy, minimal low back pain, and is returning to tennis wearing a brace.

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