Degenerative Lumbar Scoliosis, with Spondylolisthesis and Flatback Syndrome: Case 20

Case Review#20: 64 year old female with Adult Scoliosis and Flatback Syndrome from Robert Pashman

64 year old female presented with Adult Idiopathic Scoliosis, Spondylolisthesis, and Flatback Syndrome. Dr. Pashman treated the patient with a posterior spinal fusion from L1 to Pelvis. Curve was a KIM/SRP Classification 3.

    Case Review:

    Degenerative Lumbar Scoliosis, with Spondylolisthesis and Flatback Syndrome

    Patient History:

    64-year-old female
    Degenerative spondylolisthesis and scoliosis
    Status post anterior spinal fusion
    Flat back deformity, coronal and sagittal plane imbalance,
    Severe stenosis, lateral recess stenosis, L3-4 and 4-5, lateral listhesis, incapacitated with pain, narcotic addiction and obesity.
    The patient, at this point, needs reconstruction for mobilization. This has to do with quality of life issues.
    The patient is unable to ambulate at this point.

    Pre-op X-rays:

    The patient has multiple problems to be addressed. She has a lumbar curvature of 28°, Flatback Syndrome, and Spondylolisthesis.

    Indications for Surgery:

    1. Degenerative spondylolisthesis, L4-5.
    2. Critical spinal stenosis, L3-4 and 4-5.
    3. Degenerative scoliosis of the lumbar spine.
    4. Severe facet arthropathy, causing low back pain, leg pain, lumbar spine.
    5. Failed conservative therapy.
    6. Multiple comorbidities, including obesity and narcotic addiction.
    7. Status post abdominal retroperitoneal approach to lumbosacral spine.
    8. Radical diskectomy, L4-5 and L5-S1.
    9. Status post spondylolisthesis reduction and anterior spinal fusion.
    10. Severe concave scoliosis, necessitating osteotomy.11. Flat back deformity with decreased lumbar lordosis and forward decompensation.

    Surgical Strategy:

    1. Segmental spinal instrumentation, lumbar 1 to the sacrum and pelvis, with 5.5 stainless steel screw-rod construct.
    2. Sacral pelvic fixation with bilateral iliac crest exposures.3. Posterior spinal fusion,
    lumbar 1 to S1. This is a seven-level fusion, including the pelvis.
    4. Laminectomy, L3-L4, with bilateral lateral recess decompression for severe spinal stenosis.
    5. Concave osteotomy, lumbar 1-lumbar 2, lumbar 2-lumbar 3, lumbar 3- lumbar 4,
    lumbar 4-lumbar 5 and L5-S1, for mobilization of flat back deformity.
    6. Repair of incidental durotomy.
    7. Intraoperative fluoroscopy.
    8. Intraoperative somatosensory evoked potentials.

    Post-Op Films:

    The patient is doing quite well. She has some minimal low back pain, which was relieved with core strengthening exercises, weight reduction, and posture correction. Her X-rays show excellent alignment.


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