Adult Scoliosis Case 37

Case Review #37: 64 year old female with Scoliosis from Robert Pashman

The patient presented after two scoliosis surgeries and in situ fusions. The patient’s spinal curvature progressed to 80 degrees and she required revision surgery.

    Case Review:

    64 year old female with Scoliosis, status post in-situ  fusion as an adolescent.

    Patient History:

    64-year-old female
    As an adolescent had 2 operations which were in situ onlay fusions in the mid thoracic spine and the lower lumbar spine.
    Bilateral iliac crest harvesting was done.
    The patient now has adding on of progression through the thoracolumbar open segment between these 2 massive fusion masses. This is a very difficult situation because the patients insitu fusion included a greater than 80-degree proximal curve and lumbar curve. In the significantly hyper mobile lumbar segment now is collapsing and compressing through these 2, large fusion fragments.
    The patient also has a lumbosacral joint which is open and was not fused.
    Patient is small, low weight, and has multiple co-morbidities

    Indications for Surgery:

    Kim/SRP type III Adult Idiopathic Scoliosis.
    Status post posterior spinal fusion times 2 as adolescent, interval thoracic and interval lumbar spine.
    Now with nonunion and interval open mobility thoracolumbar junction at L5-S1 and proximally causing massive low back pain and progression, adding on of the thoracolumbar junction compression, lateral listhesis, instability, and degeneration.
    Massive low back pain and progression, adding on of the thoracolumbar junction compression, lateral listhesis, instability,and degeneration.
    Failed conservative therapy.
    Multiple co-morbidities, including hypertension, osteopenia and arthritis.

    Surgical Strategy:

    Segmental spinal instrumentation thoracic 3 to the sacral pelvis using 5.5 cobalt chrome high-strength rod-screw construct.
    A separate incision for sacral pelvic instrumentation of right iliac crest to a previously operated site.
    Multiple-level spinal osteotomies, Smith-Peterson osteotomy atT10- 11, T11-12, T12-L1, L1-L2 for mobilization of thoracolumbar junction and correction of interval open ankylosed Kim/SRP type III curve.
    Posterior spinal fusion at T3 to the sacral pelvis using locally-harvested autogenous bone.
    Intraoperative O arm usage with neurologic navigation.
    Intraoperative somatosensory evoked potential, motor evoked potential management.

    Post-Op Films:

    During surgery, a large fusion mass was found in the upper thoracic spine. From approximately T10-L3, there was no fusion mass. There was significant arthritis. The thoracolumbar junction was not mobile, was rotated, ankylosed, and needed osteotomy for mobility to induce correction in both the frontal and sagittal planes. The L5-S1 was not fused, either. The bone was generally of significant soft texture.

    Pre-Op/Post-op Comparison:

    At her seven month post- op appointment, the patient says that she is much better, has minimal pain. She says that it has made a significant difference in her life.
    The instrumentation is in excellent position, and the patient is well balanced.

 

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