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