Adult Scoliosis Case 43

Case Review #43: 43 year old female with Adult Idiopathic Scoliosi requiring revision surgery from Robert Pashman

43 year old female with Adult Idiopathic Scoliosis treated with an anterior spinal fusion for a double major curve. The patient was re-operated on five years later.

    Case Review:

    43 year old female treated with an anterior surgery for a double major Scoliosis curvature, and was re-operated on five years later.

    Patient History:

    43-year-old female
    Status post anterior cervical diskectomy
    Adult Idiopathic Scoliosis
    Lumbar curve with significant progression

    Bending X-rays:

    Right and left side bending shows significant flexibility of the thoracic and lumbar curve. She has some rotation of L4 and some fractional lumbosacral obliquity with right side bending but nevertheless my decision was to do a minimal operation through the anterior approach, save her posterior musculature and watch her.

    Indications for Surgery:

    1. Progressive adult idiopathic scoliosis with a 50° thoracic and 61° lumbar curve.
    2. Low back and leg pain due to progressive scoliosis.
    3. Status post anterior cervical diskectomy and fusion.
    4. Failure of conservative therapy.

    Surgical Strategy:

    Left T11 thoracoabdominal approach to the lumbar spine.
    Complete diskectomy T11-T12, L1-L2, L2-L3.
    Segmental spinal instrumentation for scoliosis correction at T12 to L3 using screw staple transvertebral instrumentation.
    Anterior interbody fusion with device, L2-3, FRA with autogenous bone and RHBMP rib.
    Anterior interbody fusion using combination of autogenous rib and RHBMP T12-L1, L1-L2 and L2-L3.
    Intraoperative somatosensory evoked potential monitoring.
    Intraoperative fluoro.

    Patient History:

    48-year-old female
    Kim SRP type III curve.
    Originally attempted to be fixated with anterior fixation with transvertebral screws at thoracolumbar spine. This ultimately did well for quite some time, but the patient now has what happens to be subadjacent degeneration, increasing at a proximal curve, on balance shortening, and has pain.

    Indications for Surgery:

    1. Kim/SRP type III adult idiopathic scoliosis.
    2. Status post anterior spinal fusion of thoracolumbar curve.
    3. Now with subadjacent degeneration and adding on increasing curvature.
    4. Failure of distal fixation of anterior fixation and increasing proximal thoracic curve.
    5. Lumbosacral degeneration L4-5 and L5-S1.

    Surgical Strategy:

    Abdominal retroperitoneal approach to lumbosacral spine. Complete radical diskectomy L4-5, L5-S1. Interbody fusion using PEEK device. Femoral ring allograft (FRA) and Alphatec L4-5 and L5-S1 with allograft putty centrally and autogenous bone, plus blood. Anterior screw fixation, L4-5 and L5-S1. Intraoperative use of fluoroscopy. T3 to sacropelvic fusion using segmental spinal instrumentation, titanium cobalt chrome rod pedicle screw construct.< Sacropelvic fixation with separate iliac crest exposure right iliac crest. Posterior spinal fusion T3 to the S1 using locally harvested autogenous bone allograft putty. Smith Peterson osteotomy T5-6, T6-7, T7-8, T7-9, T8-9, T9-10, T10- 11, T12-L1, L1-2, L2-3 for inducing flexibility for balance correction KIM-SRP III type curve. Neuronavigation using O-arm Stealth computer navigation and interpretation. Intraoperative somatosensory evoked potentials motor evoked potentials. Plastic closure of wounds.

    Post-op Films:

    The patient is well balanced in both the sagittal and coronal planes.
    She is very happy with her  outcome, and lives a full and active life.

 

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