Adult Scoliosis Case 33

Case Review #33: 49 year old Dancer presented with Idiopathic Scoliosis from Robert Pashman

A 49 year old male with Adult Scoliosis presented with low back pain and leg pain. The patient is a professional dancer. He failed conservative therapy and was seeking a surgical opinion.

    Case Review:

    49 year old male with Adult Idiopathic Scoliosis

    Patient History & Pre-op X-rays:

    49-year-old male Degenerative and Adult Idiopathic Scoliosis of the lumbar spine KIM/SRP type II
    Significant low back and leg pain. He has failed conservative therapy.

    Indications for Surgery:

    1. Adult idiopathic/de novo degenerative scoliosis lumbar spine.
    2. Severe degenerative disk disease lumbar spine.
    3. Severe low back and radicular pain due to the above diagnoses.
    4. Failed conservative therapy.5. Multiple co-morbidities including gastroesophageal reflux disease, hypercholesterolemia, migraines and insomnia.

    Surgical Strategy – Stage 1:

    Abdominal retroperitoneal approach to lumbosacral spine. Radical diskectomy L5-S1 with epidural decompression.
    Radical diskectomy L4-5 with epidural decompression.
    Anterior interbody fusion using femoral ring allograft device with putty graft centrally 13 mm, L5-S1.
    Anterior interbody fusion using femoral ring allograft device with putty centrally 13 mm, L4-5.Anterior screw fixation L4-5 and L5-S1 with a full threaded screw over a washer.
    Intraoperative somatosensory evoked potentials.
    Intraoperative fluoroscopy.

    Stage 2:

    Segmental spinal instrumentation, T10 to the sacral pelvis. This is an 8-level posterior instrumented fusion using ¼”stainless steel pedicle screw-rod construct.
    Sacropelvic fixation using iliolumbar-iliac screw, right hand side measuring 7.5x 70.
    Posterior spinal fusion using a combination of BMP and locally harvested autogenous bone, T10 to the sacral pelvis.
    Interlaminar decompression, L1-2, L2-3, L3-4, L4-5 and L5-S1 for lateral recess stenosis radiculopathy bilaterally.
    Spinal osteotomies, repeat osteotomy, thoracolumbar spine, L1-2,L2- 3, L3-4, L4-5 with facetectomy for spinal loosening and correction of lumbar scoliosis.
    Intraoperative SSEP.
    Intraoperative fluoroscopy.

    Post-Op Films:

    The patient is a professional dancer, and was in excellent shape prior to surgery. He did fantastic after surgery, requiring very little pain medication, and resumed his normal activities fairly quickly. He returned to work as a professional dancer and has reported minimal pain.

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