Adult Scoliosis Case 9

Case Review #9: Adult Idiopathic Scoliosis with a Double Curvature from Robert Pashman

A 54 year old female presented with Adult Idiopathic Scoliosis.  In addition to lower back pain, she noticed that her height was decreasing. Her spine was significantly rotated and she required a spinal fusion.

    Case Review: 

    Adult Idiopathic Scoliosis, Double Curvature

    Patient History:

    54-year-old female.Adult Idiopathic Scoliosis.Her height has been decreasing.She has low back and upper back pain.Status post anterior interbody fusion of the cervicalspine. Fibromyalgia, Epstein-Barr, chronic fatigue syndrome. She has a combination of low back and leg pain.

    Pre-op X-rays:

    Double curve that measure 57° thoracic, 67° lumbar
    She is significantly rotated

    Indications for Surgery:

    1. Progressive adult idiopathic scoliosis, 57° thoracic, 67° lumbar.
    2. Significant low back and leg pain due to the above diagnosis with lateral recess neural foraminal stenosis.
    3. Multiple co-morbidities including fibromyalgia, Epstein- Barr, and chronic fatigue syndrome.
    4. Failed conservative therapy.
    5. Frontal and sagittal plane decompensation.

    Surgical Strategy:

    1. Segmental spinal instrumentation, thoracic 3 to sacral pelvis using pedicle screw-rod construct. This is a 15 level spinal fusion for adult idiopathic scoliosis.
    2. Posterior spinal fusion, thoracic 3 to sacral pelvis using locally harvested autogenous bone and rhBMP.
    3. 12-level spinal osteotomy with Smith-Peterson osteotomy, bilateral lateral facet resections for mobilization of adult idiopathic curve.
    4. Interlaminar decompressions for lateral recess stenosis, Lumbar 1- 2, 2-3, 3-4, 4-5, and 5-1, bilaterally.
    5. Intraoperative somatosensory-evoked potentials and motor- evoked potentials.
    6. Intraoperative fluoroscopy.
    7. Placement of Mayfield tong pin fixation for mobilization and positioning.

    Post-Op Films: 

    The patient is doing quite well. She has no significant complaints of pain. Her headaches have significantly reduced.

    Pre-Op/Post-op Comparison:

    The patient is well-balanced in the frontal and sagittal plane. There is no appearance of hardware pull-out, and we are quite satisfied with her result.

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