Adult Scoliosis Case 51

Case Review #51: 59 year old Female with Collapsing Scoliosis from Robert Pashman

A 59 year old female presented to Dr. Pashman with a 60 degree throacic curve, in extreme pain. She failed conservative therapy and opted to have scoliosis surgery.

    Case Review:

    59 year old female with 60° collapsing and painful Adult Idiopathic Scoliosis

    Patient History:

    59-year-old female with a 60-degree thoracic, 60-degree lumbar KIM/SRP type 3 curve with significant 30- degree thoracolumbar kyphosis making this a KIM 3 classification.
    The patient has failed conservative therapy.
    The curve is collapsing and progressive and is painful.

    Pre-op X-rays:

    KIM/SRP type 3 curve that is measuring 60 degree thoracic, 60 degree lumbar with  significant rotation lumbar, and at least a 30-degree thoracolumbar kyphosis.

    Indications for Surgery:

    1. KIM/SRP type 3 adult idiopathic scoliosis with greater than 50 degrees thoracolumbar curvature.
    2. Thoracolumbar kyphosis with significant degeneration greater than 20 cm, greater than 30 degrees thoracolumbar kyphosis.
    3. Severe low back pain and radicular symptoms due to 60 degrees thoracic, 60 degrees lumbar KIM/SRP type 3 adult idiopathic scoliosis and rotation.
    4. Failed conservative therapy.

    Surgical Strategy – part 1:

    Abdominal retroperitoneal approach to lumbosacral spine.
    Radical diskectomy L5-S1.
    Interbody fusion with polyetheretherketone device, 10-mm medium with rhBMP centrally.
    Anterior screw fixation L5-S1.
    Intraoperative somatosensory evoked potentials.
    Intraoperative fluoroscopy.

    part 2:

    Thoracic 3 to sacral pelvic segmental spinal instrumentation using 1/4-inch stainless steel screw-rod complex.
    Posterior spinal fusion T3 to sacral pelvis using locally harvested autogenous bone mixed with cancellus allograft in the bone mill.
    Multiple level Smith-Petersen osteotomy at T10-11, T11-12, T12-1, T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, as well as T5-T6, T6-T7, T8-T9 and T10-T11.
    Intraoperative O-arm neuro navigation.
    Intraoperative SSEP motor evoked potential evaluation.

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