Kyphosis Case 11

Case Review #11: Adult Idiopathic Scoliosis from Robert Pashman

A 60 year old male presented with a 50+ degree curvature. He was status post lumbar fusion from L4-S1, and continued to have significant low back pain.

    Case Review:

    Adult Idiopathic Scoliosis treated with a spinal fusion from T2 to Pelvis

    Patient History:

    60-year-old female. Adult Idiopathic Scoliosis, 50+ degree curvature. Status post anterior interbody fusion at L4-5 and L5-S1.The patient has significant thoracic kyphosis and thoracolumbar kyphosis. She reports increased pain over this area.The patient has significant left lumbar fullness. She isdecompensated to the left.The patient is losing height.Intermittent radiculopathy

    Pre-op X-rays:

    She has a severe kyphoscoliosis with a 70° thoracolumbar curve. It is a fixed deformity including frontal and sagittal plane decompensation.

    Indications for Surgery:

    1. Adult idiopathic scoliosis, thoracolumbar curve greater than 70 degrees.
    2. Fixed lumbosacral kyphosis.
    3. Degeneration obliquity.
    4. Thoracic kyphosis due to kyphoscoliosis.
    5. Severe low back pain, leg pain due to the above diagnoses with lateral recess
    stenosis, L1-2 to L5-S1, due to curvature.
    6. Failed conservative therapy.
    7. Status post anterior abdominal retroperitoneal fusion, L4- 5, L5-S1

    Surgical Strategy:

    1. Segmental spinal instrumentation, T2 to sacral pelvis. This is a 16- level fusion using Cotrel-Dubousset Legacy 5.5 stainless steel screw rod construct with pelvic fixation.
    2. Sacropelvic fixation.
    3. Posterior spinal fusion, T2 to the pelvis, using locally harvested autogenous bone as well as RHBMP.
    4. Spinal osteotomy for mobilization of rigid kyphoscoliosis, including Smith-Peterson
    osteotomies, T4 to L3, with bilateral facet removal and interlaminar decompression. This is an 11- level osteotomy.
    5. Interlaminar decompression, T1 to L5-S1 bilaterally.
    6. Interlaminar decompression for stenosis using Loup magnification.
    7. Intraoperative motor evoked potentials and somatosensory evoked potentials.
    8. Intraoperative fluoroscopy.

    Post-Op Films:

    At 7 months post-op the patient is doing very well. No specific pain but she has some fatigue which is normal.

    Pre-Op/Post-op Comparison:

    The patient’s curvature was reduced by 84%