Adult Scoliosis Case 52

Case Review #52: 54 Year Old Female with Adult Idiopathic Scoliosis and leg pain from Robert Pashman

A 54 year old female with progressive Idiopathic Scoliosis presented with low back pain and leg pain. Due to her daily function declining, the patient chose to have spinal surgery.

    Case Review:

    54 year old female, with Progressive Adult Idiopathic Scoliosis and leg pain

    Patient History:

    54-year-old female
    Greater than 50 degree Kim/SRP type 2 Adult Idiopathic Progressive Scoliosis with decompensation
    Low back pain, leg pain
    The patient says her functional tolerance is degrading with time which is classic of highly angular and degenerative scoliosis specifically with a fractional kyphotic component

    Pre-op X-rays:

    She is decompensated in the coronal plane to the right approximately 2 cm, and has a fractional lumbar kyphosis. She has asymmetric folds on the left- hand side as opposed to the right. This is due to truncal shift and59° scoliosis of the low lumbar spine. Otherwise she is neurologically intact.

    Kim/SRP type 2 adult idiopathic scoliosis, progressive, greater than 50 degree curve
    Fractional lumbar kyphosis.
    Preoperative for posterior instrumented fu

    Indications for Surgery

    1. Kim/SRP type II Adult Idiopathic Scoliosis, progressive, greater than 50 degree curve
    2. Fractional lumbar kyphosis.
    3. Low back and leg pain.
    4. Coronal and sagittal decompensation with thoracolumbar kyphosis, decompensation of the fractional lumbar curve to the right, significant rotation of the spine, and status post anterior- posterior spinal fusion L4-5, L5-S1.

    Surgical Strategy – Stage One:

    Abdominal retroperitoneal approach to the lumbosacral spine.
    Radical diskectomy, L4-5, L5-S1.
    Interbody fusion with ALIF device, 10-mm medium L4-5, L5- S1.
    Anterior screw fixation L4-5, L5-S1 fully threaded screw over rod.

    Stage Two:

    T10 to sacral pelvic posterior instrumented fusion using ¼ inch stainless steel pedicle screw/rod construct.
    Posterior spinal fusion T10 to the sacral pelvis with locally harvested autogenous bone and allograft.
    Smith-Petersen osteotomy to induce flexibility and coronal and sagittal plane correction L1-2, L2-3, L4-5 and T10-11.
    Intraoperative neuro navigation with O arm.
    Intraoperative somatosensory evoked potential and motor evoked potential monitoring.

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