Adult Scoliosis Case 4

Case Review #4: 31 year old woman with Adult Idiopathic Scoliosis from Robert Pashman

A 31 year old woman, with Adult Idiopathic Scoliosis, 75° stiff lumbar curve, rotated 90°. Dr. Pashman treated the patient with and Anterior Spinal Fusion followed by a Posterior Spinal Fusion. KIM/SRP Classification 2.

    Case Review:

    Adult Idiopathic Scoliosis with Lumbosacral Kyphosis: Treated with Anterior and Posterior Spinal Fusion

    Patient History:

    31 Year old female
    Diagnosis: Progressive Adult Idiopathic Scoliosis with Lumbosacral Kyphosis
    Patient diagnosed at age 12, did not wear her brace
    Four inch height loss
    Low back pain, leg pain
    Failed to respond to conservative therapy

    Pre-Operative X-Rays:

    75° curvature of the lumbar spine, rotated approximately 90° 
    2 cm decompensation

    Bending X-rays:

    The patient has a very stiff lumbar obliquity that does not correct on right or left side bending.

    Surgical Strategy:

    Radical discectomy of T10-L1 (7 levels)
    Anterior interbody fusion L4-S1, using PEAK and autogenous rib bone graft T10
    Anterior interbody fusion T10-L4 L1 using morselized bone graft L4
    Posterior Spinal Fusion T10 to S1 Sacral Pelvis

    Results:

    The original surgical plan was to fuse T10 to S1. Spinal balance was achieved by T12, therefore two levels were spared.

    Pre-Op/ Post-op Comparison:

    A correction of 57% was obtained. The lumbar kyphosis has been corrected in the frontal plain.
    Thoracic kyphosis corrected. The pre-operative pain that she was experiencing in her back and legs has significantly decreased, and she requires minimal pain medication. The patient is quite pleased with her appearance.

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