Adult Scoliosis Case 55

Case Presentation #55: 63 year old with junctional kyphosis after scoliosis surgery from Robert Pashman

A 63 year old female presented after having scoliosis surgery 35 years prior. The patient had junctional kyphosis and opted to have scoliosis revision surgery due to severe low back, thoracic, and neck pain.

    Case Review:

    63 year old woman with junctional kyphosis after surgery for Adolescent Scoliosis.

    Patient History:

    63-year-old female
    Status post selective thoracic fusion 35 years ago for adolescent idiopathic scoliosis
    King Mo type 1
    Failure to thrive due to proximal and distal pain.
    Now with severe low back, neck and cervical thoracic pain

    Pre-op X-rays:

    She has proximal junctional kyphosis above the Harrington distraction instrumentation as well as subjacent degeneration of the compensatory curve status post selective thoracic fusion. The lumbar compensatory curve was highly rotated and progressive greater than 50° with severe degeneration and the patient had critical low back pain, spinal stenosis

    Indications for Surgery:

    1. Adult idiopathic scoliosis King Mo type 1 or Lenke 1C versus 3 double major curve
    greater than 50 degrees subjacent compensatory.
    2. Status post selective thoracic fusion 35 years ago for adolescent idiopathic scoliosis
    King Mo type 1.
    3. Now with subjacent degeneration, compensatory curves subjacent to previous selective thoracic fusion.
    4. Proximal junctional kyphosis status post Harrington distraction rod instrumentation and selective thoracic fusion.
    5. Now with severe low back, neck and cervical thoracic pain due to the above diagnosis.
    6. Failed conservative therapy.

    Surgical Strategy:

    Segmental spinal instrumentation thoracic 2 to sacral pelvic spinal instrumentation using quarter-inch stainless steel screw rod construct.
    Posterior spinal fusion T2 to sacral pelvis using locally harvested autogenous bone mixed with cancellus allograft chips.
    Multilevel Smith-Petersen osteotomy T10-11, T11-12, T12-L1 for correction of junctional thoracolumbar kyphosis subjacent to previous fusion.
    Spinal osteotomy previous fusion mass for removal of Harrington rod.
    Removal of Harrington rod instrumentation with up and down hooks in the thoracic and lumbar spine.
    Intraoperative O-Arm neuro navigation.
    Intraoperative SSEP motor-evoked potentials.

    Post-op Films:

    The patient is balanced in both the sagittal and coronal plane.

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