A 43 year old woman, presented with Adult Idiopathic Scoliosis, 50° lumbar curve. Dr. Pashman treated her with Posterior Spinal Fusion from T9 – L5. Curve was a KIM/SRP Classification 2.
Adult Idiopathic Scoliosis with a 50° Lumbar Curve
43 yo female, increasing pain over her left lumbar curve.
She has tried chiropractic, physical therapy, massage, injections, anti-inflammatories.
The pain is severe.
On physical examination, she has typical right flank elevation.
She has decompensation to the left. Sagittal plane is good.
She has a slight right rib hump.
36×14 x-rays show a 45° left lumbar curve which increased from 40° in 2001.
She has rotation or lateral listhesis of L3 on 4, and is decompensated approximately 3-4 cm to the left. She has good sagittal plane.
On bending films, she does not correct her L4 over 5, but these are not forced bending films, as far as I can say. She also has apical degeneration through the apex of the curve which is significant. This was not present on 2001 films.
Indications for Surgery:
50° thoracolumbar adult idiopathic scoliosis, progressive.
Severe low back pain and radiculopathy.
Degenerative disc disease, lumbar spine.
Failed conservative therapy.
Severe rotation sagittal plane deformity causing the above diagnoses.
Segmental spinal instrumentation using pedicle screw, rod construct, 5.5 stainless steel T9 to L5, eight levels.
Posterior spinal fusion, T9 to L5, eight levels, using a combination of autogenous and BMP bone.
Interlaminar decompression, lateral mesial facetectomy, lateral recess release, neural foraminotomy for spinal stenosis, L1-2, L2-3, L3-4, and L4-5 bilaterally.
Spinal osteotomy for mobilization of stiff rigid posterior adult idiopathic spine, L1-2, L2-3, L3-4, and L4-5.
Autogenous bone graft harvesting.
Intraoperative somatosensory-evoked potentials.
The patient is doing well. Hardware looks good. Balance is excellent. Two months post-op, she has minimal pain and has increased her activities.