Adult Scoliosis failed Minimally Invasive Xlif : Case 54

Case Presentation #54: 60 year old female failed minimally invasive scoliosis surgery from Robert Pashman

A 60 year old woman presented after a failed minimally invasive XLIF surgery for Adult Idiopathic Scoliosis. The patient had multiple complications, and required extensive revision surgery.

    Case Review:

    60 year old Female status post failed Minimally Invasive Surgery for Adult Idiopathic Scoliosis

    Patient History:

    60-year-old female
    Status post an attempt at scoliosis correction with multiple level XLIF and a percutaneous transfascial para lumbar percutaneous pin fixation that was ultimately removed.
    The patient did not do well. She has an iatrogenic flat back with collapse kyphosis probable pseudarthrosis 2 to L3. She had significant sagittal and coronal displacement and the patient is completely disabled from her symptoms.

    Pre-op X-rays:

    The patient will need pedicle subtraction osteotomy to reduce sagittal plane balance and she knows that this a significant morbid operation because of the redo nature.

    Indications for Surgery:

    1. Status post “minimally invasive scoliosis correction with XLIF and percutaneous instrumentation lumbar spine.
    2. Complete failure of minimally invasive scoliosis correction with removal of implants and collapse.
    3. Iatrogenic kyphosis lumbar spine.
    4. Multiple level pseudoarthrosis lumbar spine status post minimally invasive scoliosis correction adult idiopathic scoliosis.
    5. Severe flat back with low back plane in forward decompensation.
    6. Failed conservative therapy.
    7. Status post removal of a paraspinous boil.

    Surgical Strategy:

    Segment 1, segmental spinal instrumentation thoracic 10 to pelvis using quarter-inch stainless steel rod screw construct.
    Pedicle subtraction osteotomy in lumbar 3 with complete kyphectomy, vertebrectomy L3 under the microscope.
    Laminectomy L2-L4 with spinal canal decompression under the microscope.
    Posterior spinal fusion T10 to sacral pelvis using locally harvested autogenous bone and Rh BMP.
    Intraoperative operating room neuro navigation.
    Intraoperative SSEP motor-evoked potential.

    Post-op Films:

    The patient did very well post- operatively, and was very grateful for her results.

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