Kyphosis Case 10

Case Review #10: Adult Idiopathic Scoliosis with a Triple Curve from Robert Pashman

A 24 year old female presented with Idiopathic Scoliosis. She had been braced as a teenager, and the curve progressed to 60 degrees and she required surgery.

    Case Review:

    Adult Idiopathic Scoliosis with a triple curve

    Patient History:

    24 year old female Scoliosis followed as a teenager. The patient was told that her curve was too big for bracing.The curve has progressed, and the patient has lost height.0.5 cm right rib and left flank fullness. Decreased flexibility of the spine, and a noticeable curve.The patient has lumbosacral take off. Her shoulder is down on the right-hand side classified as a Lenke type 4B curve with upper thoracic, thoracolumbar decreasedlumbar lordosis.

    Pre-op X-rays:

    The patient presented with a 43° upper thoracic, 60° thoracic, and 48° lumbar curve, all three curves are rotated.

    Bending X-rays:

    On right and left bending, the curve is very stiff with only minimal correction. The thoracic and lumbar curve bends down to greater than 35° which would classify this as structural curve. She has left lumbar fullness. The lumbosacral junction does not auto correct either.

    Indications for Surgery:

    1. Adult idiopathic scoliosis, triple major curve measuring thoracic and upper thoracic and 48° lumbar with severe rotation.
    2. Rigid coronal plane deformity.
    3. Severe superimposed degenerative disc disease and facet arthropathy with lumbar degeneration.
    4. Low back and lower extremity symptoms with upper back pain.
    5. Failed conservative therapy.6. Progressive deformity and right rib hump.

    Surgical Strategy:

    1. Segmental spinal instrumentation, thoracic-2 to lumbar-3; this is a 13-level
    instrumentation with 5.5 stainless steel Legacy screw rod construct.
    2. Posterior spinal fusion, thoracic-2 to lumbar-3, with autogenous bone graft.
    3. Multiple level Ponte osteotomy radical mobilization of the spine with complete facetectomy resection, thoracic-5 to lumbar-3-4; this is a 10-level osteotomy with correction of coronal and sagittal plane deformity.
    4. Subtotal laminectomy, thoracic-12 to lumbar-1, for mobilization of thoracolumbar spine.
    5. Intraoperative motor-evoked potential interpretation.
    6. Intraoperative fluoroscopic interpretation.
    7. Plastic closure.
    8. Chest wall resection with thoracoplasty of five ribs for reduction of rib hump.

    Post-Op Films:

    X-rays look excellent. There is no change of the vertebrae or alignment.

    Pre-Op/Post-op Comparison:

    The patient is doing quite well, she has no complaints and is not taking any pain medication.
    The patient is well balanced in both the frontal and sagittal planes