Adult Idiopathic Scoliosis: Case 35

Case Review #35: 43 year old female with Adult Idiopathic Scoliosis and a Transitional Vertebra from Robert Pashman

A 44 year old woman presented with Adult Idiopathic Scoliosis. She wore a brace as a child, and the curvature progressed to the point she required surgery.

    Case Review:

    43 year old female with Adult Scoliosis and lumbar sacral transitional vertebra.

    Patient History:

    43-year-old female.
    Diagnosed with Scoliosis at age 3.
    Right leg pain.
    Failed conservative therapy.
    The patient has a fairly large right thoracolumbar prominence on forward bending and she has a truncal shift to the right.
    She is otherwise balanced in the sagittal plane.

    Pre-op X-rays:

    The patient has a lumbar curve measuring approximately 40°. She also has a transitional L5-S1 segment with a fused L5-S1 region on the right.

    Indications for Surgery:

    1. Kim/SRP type II adult idiopathic scoliosis.
    2. Adult idiopathic possible congenital and degenerative scoliosis.
    3. Severe low back pain due to multiple-level degenerative disk disease.
    4. Multiple-level foraminal lateral recess stenosis with combination of low back and leg pain.
    5. Failed conservative therapy.
    6. Coronal and sagittal plane deformity.
    7. Bilateral facet arthropathy due to degeneration.
    8. Multiple comorbidities including narcotic tolerance.
    9. Radiculopathy.
    10. Lumbosacral transitional vertebrae.

    Surgical Strategy:

    Anterior interbody fusion L4-5
    Segmental spinal instrumentation using and L5-S1 with radical quarter-inch stainless steel screw-rod
    diskectomy and epidural construct, for Kim/SRP type II scoliosis, decompression thoracic 10 to sacral pelvis.
    Abdominal retroperitoneal Spinal osteotomy, multiple level, for approach to the lumbosacral correction of sagittal plane and coronal spine scoliosis deformity, L1-2, L2-3, L3-4, L4-
    Interbody fusion with with autogenous bone centrally L4-5,
    Posterior spinal fusion using locally-L5-S1.
    harvested autogenous bone and rhBMP,
    Anterior screw fixation L4-5, L5- T10 to the sacral pelvis.S1.
    Pelvic fixation with bilateral exposure
    Reduction kyphosis and through iliac crest through separate correction of coronal plane incision deformity lumbosacral joint. Intraoperative SSEP with motor-evoked potentials
    Intraoperative somatosensory
    Intraoperative O-arm localization and Intraoperative fluoroscopy

    Post-Op Films:

    The patient is well balanced in the sagittal plane. She is very happy with her outcome, and reports no symptoms.

 

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