Adult Idiopathic Scoliosis and a broken Luque Rod: Case 36

Case Review #36: 34 year old female with Adult Idiopathic Scoliosis and a broken Luque Rod from Robert Pashman

34 year old female with Adult Idiopathic Scoliosis and a broken Luque Rod that dislodged through her skin. Dr. Robert Pashman treated the patient with a posterior spinal fusion from T2-Pelvis. KIM/SRP Classification 3.

    Case Review:

    34 year old female with Idiopathic Scoliosis, and a broken Luque Rod.

    Patient History:

    34-year-old female.
    Adolescent Idiopathic Scoliosis.
    The patient had a spinal fusion with Luque instrumentation placed in The Philippines at age 13.
    Recent pregnancy.
    The patient was admitted to the hospital because the Luque rod had broken and had moved it was pointing and piercing the skin to the level of her mid buttock.
    At that time the piece of the rod was removed.The patient on 36 x 14 x-rays has residual Luque instrumentation which is fractured, broken, all wires are broken, and the fixation is lost.

    Pre-op X-rays:

    The patient has greater than an 86° residual large thoracic curve. This is a significant problem because she does not have a fusion. The proximal instrumentation is pointing on the left-hand side and will probably break through the skin. The patient is loosing height and I think that this is a very significant serious issue at this point. The patient and needs a posterior removal of the instrumentation, placement of the screws with O arm and a T2 to sacral pelvic fusion. Will classify this is a King III curve and the patient needs to be taken to the pelvis because this is the only way to balance the patients coronal and sagittal plane, especially with a long fusion that involves tilting of L5 and L4.

    Indications for Surgery:

    1. Failed adolescent, now adult idiopathic scoliosis.
    2. Status post Luque sublaminar wire fixation.
    3. Failed hardware.
    4. Progressive adult idiopathic scoliosis measuring 90° for the primary curve, 70° for the upper thoracic rigid curve and a fractional lumbosacral curve.
    5. Fracture of the rod and dislocation of the hardware through the skin, status post 6 months ago.
    6. Now with decompensation in forward and sagittal plane.
    7. Unable to ambulate with increasing pain and neurologic deficits.
    8. KIM/SRP type III

    Surgical Strategy:

    Segmental spinal instrumentation T2 to sacral pelvis using 5.5 stainless steel pedicle screw/rod construct.
    Bilateral single lateral pelvic fixation through a separate incision.
    Posterior spinal fusion using the combination of autogenous bone morphogenic protein and allograft bone T2 to sacral pelvis.
    Removal of retained hardware Luque rods.
    Multiple level Smith-Peterson osteotomy for mobilization of semi rigid failed thoracic ostia spine including osteotomies of T3- 4, 4-5, T5-6, T6-7, T7-8, T8-9, T9-10, T10-11, T12-L1, L1-L2.
    Intraoperative O-arm neuronavigation.
    Debridement of old hardware fixation inflammatory tissue with intra operative biopsy.
    Intraoperative somatosensory evoked potentials management.

    Post-Op Films:

    The patient is perfectly balanced in both the saggittal and coronal plane.

 

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