Adult Scoliosis Case 56

Case Presentation#56: Adult Idiopathic Scoliosis from Robert Pashman

A 28 year old female with progressive Adult Idiopathic Scoliosis postponed surgery from age 17 to 28. The patient failed conservative therapy and decided to have surgery due to pain and curve progression.

    Case Review:

    28 year old female with progressive Adult Idiopathic Scoliosis

    Patient History:

    28-year-old female
    The patient has been waiting to have surgery for quite some time.  She was originally scheduled in 2000, at age 17.
    The curve is progressive. In 2006 it was a 50-degree thoracolumbar curve and in June 2010,
    it was 58 degrees.
    She also has some structurality to the upper thoracic curve as evidenced by depression
    of her right shoulder.

    Pre-op X-rays:

    58° right highly rotated, progressive thoracolumbar curve. Kim/SRP type 1 curve

    Bending X-rays:

    On right and left side bending thoracolumbar curve is highly flexible, but the structural left upper curve is not. Therefore the strategy is at T2-L3 to induce balance because on left side bending L3 horizontalizes over the mid sacrum.

    Indications for Surgery:

    1. 58 degree right thoracolumbar curve.
    2. Structural left high thoracic curve.
    3. Progression of adult idiopathic scoliosis.
    4. Thoracic and low back pain.
    5. Failed conservative therapy.

    Surgical Strategy:

    Segmental spinal instrumentation thoracic to lumbar.• Using the quarter inch stainless steel rod screw construct.• Posterior spinal fusion T2 to L3 using locally harvested autogenous bone, allograft croutons and RhBMP.• Multiple level Smith-Petersen osteotomy for induction of flexibility T3-4, T4-5 to T12-L1 that is a 7 level osteotomy.
    Intraoperative O-arm neuro navigation
    Intraoperative motor evoked potential interpretation.

    Post-op Films:

    The patient is well balanced in the coronal and sagittal plane. She is very happy with the outcome of her surgery.

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