Adult Denovo Scoliosis: Case 44

Case Review #44: 64 male presented with Denovo Scoliosis and Infection from Robert Pashman

A 64 year old male presented with collapsing denova scoliosis, after several failed back surgeries. The patient was found to have an infection and required salvage surgery.

    Case Review:

    64 year old male, with collapsing Scoliosis, presented status post multiple decompression surgeries and with an infection.

    Patient History:

    64-year-old male Adult Idiopathic Scoliosis. The patient presented status-post multiple explorations, interval laminectomy decompressions and at he had an epidural abscess postoperatively. The patient was then treated for epidural abscess and had multiple course x6 weeks with PICC line placement. The patient has a significant neurologic deficit with bilateral EHL, tibialis anterior weakness due to collapsing scoliosis and crushing of his nerve roots.

    Pre-op X-rays:

    As you can see, the patient is pitched forward. (his head is not over his hips.) This puts a strain on his neck as he attempts to keep his gaze forward. The patient is decompensated 11 cm forward.

    Indications for Surgery:

    1. Status post laminectomy for spinal stenosis on January 13, 2009.
    2. Status post re-exploration for epidural abscess status post wound infection on
    February 25, 2009.
    3. Now with collapsing scoliosis, degenerative disc disease and unremitting neurologic deficit due to the above diagnosis, lumbar spine.4. KIM/SRP type 2 adult de-novo scoliosis status post laminectomies with massive instability of the lumbar spine.
    5. Multiple co-morbidities including diabetes status post infection, osteopenia, hypertension, and failure to thrive.
    6. Now with dysfunctional low back pain and leg pain due to collapsing scoliosis by recessed stenosis degeneration currently on antibiotic therapy for epidural abscess of the lumbar spine.

    Surgical Strategy:

    T10 to sacral pelvis posterior instrumented fusion for Kim/SRP 2 adult progressive de-novo idiopathic scoliosis.
    Re-exploration and decompression of L2 to S1 status post epidural abscess and re-decompression.
    Interval spinal osteotomy for induction of lumbar release of L1- 2, L2-3, L3-4. These were Smith-Peterson osteotomies with removal of intervening bone for correction of KIM/SRP type 2 adult scoliosis.
    Posterior spinal fusion T10 to S1 using locally harvested autogenous bone and iliac crest bone and RhBMP.
    Bilateral iliac crest exposure for placement of pelvic instrumentation.

    Bilateral iliac crest harvesting for autogenous bone graft pelvis.
    Intraoperative use of image guidance and intraoperative CT scan interpretation using O-arm radiology.
    Intraoperative SSEP and motor-evoked potential interpretation.

    Post-op Films:

    The patient’s balance has been restored in both the sagittal and coronal plane.
    His head is now balanced over his hip, reducing the strain on his neck.

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