Adult Scoliosis Case 15

Case Review 15: Adult Scoliosis treated with Spinal Fusion and Oteotomies from Robert Pashman

A 50 year old female presented with progressive Adult Idiopathic Scoliosis. The patient had severe low back pain and leg pain. She was treated with a posterior spinal fusion with spinal osteotomies.

    Case Review:

    Adult Idiopathic Scoliosis treated with Spinal Fusion and Osteotomies

    Patient History:

    50-year-old female
    Idiopathic Scoliosis, with a progressive 65° lumbar,highly rotated curve
    The patient presented with severe radiculopathy, this because the curve ended at L4-5 with severe degeneration, collapse and lateral recess stenosis. The radiculopathy and low back pain, plus the progressive nature of the scoliosis is an indication for surgery.
    The patient was originally told that she could have a decompression for minor radiculopathy, but because of the progressive curvature, the patient wished to forego that and proceed with major reconstruction of her spine.

    Bending X-rays:

    Note that the spine is rigid on side bending.

    Indications for Surgery:

    65° progressive lumbar scoliosis with thoracolumbar compensatory curve.
    Degenerative spondylolisthesis L4-5.
    Severe L5 radiculopathy, left leg.
    Failed conservative therapy, now with progressive deformity.

    Surgical Strategy:

    Thoracic 2 to sacral pelvis posterior segmental spinal instrumentation using 5.5 stainless steel screw/rod construct. This is a 19-level fusion, thoracolumbar spine.
    Posterior spinal fusion thoracic 2 to sacral pelvis.
    Multiple-level spinal osteotomy, Smith-Peterson osteotomy from T5 down to L4-5. This is a 12-level osteotomy for mobilization of stiff adult progressive scoliosis.
    Interlaminar decompression, L4-5, removal of disc herniation under loupe magnification and decompression of L5 nerve root.
    Subtotal laminectomy, L1-2, L2-3, L3-4, L4-5 for decompression of lateral recess and mobilization of spine and placement of lumbar pedicle screws.
    Intraoperative fluoroscopy.
    Intraoperative motor evoke potential interpretation.

    Post-Op Films:

    The x-rays look good. She is well balanced in frontal and sagittal planes. She has no radiculopathy

    Pre-Op/Post-op Comparison:

    The patient’s scoliosis curvature was reduced 85% from 65° to 10°.
    Recreation of normal sagittal alignment has the added benefit of relieving strain on the neck and head.

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