Adult Idiopathic Scoliosis and Isthmic Spondylolisthesis, treated with a Posterior Spinal Fusion from T2 to Pelvis: Case 22

Case Review #22: 50 year old female presented with Scoliosis and spondylolisthesis from Robert Pashman

50 year old female presented with Adult Idiopathic Scoliosis and Spondylolisthesis. She suffered from low back pain and leg pain. Dr. Pashman performed a spinal fusion on the patient.

    Case Review:

    Adult Idiopathic Scoliosis and Isthmic Spondylolisthesis, treated with a Posterior Spinal Fusion from T2 to Pelvis

    Pre-op X-rays:

    50-year-old female
    Adult Idiopathic Scoliosis, with a triple major curve.
    On physical examination, she has right thoracic fullness, left lumbar fullness Grade I spondylolisthesis L5-S1
    Right shoulder depression due to the high thoracic curve.
    Low back pain
    Leg pain

    Indications for Surgery:

    Adult idiopathic scoliosis, triple major curve.
    Grade I spondylolisthesis L5/S1.
    Thoracic kyphosis.
    Severe back and lower extremity pain due to the above diagnoses.
    Failed conservative therapy.
    Multiple level degeneration causing decompensation involvement necessitating anterior spinal fusion and multiple level osteotomies posteriorly.
    Asymmetric slipped lateral listhesis L4-5.

    Surgical Strategy:

    1. Segmental spinal instrumentation of thoracic 2 to the pelvis, a 16 level with 5.5 stainless steel pedicle screw rod construct.
    2. Pelvic instrumentation with exposure of iliac crest on the right separately.
    3. Intralaminar laminotomy for recess stenosis under the microscope and neural
    foraminotomy L1-2, L2-3, L3-4, L4-5, L5-S1 bilaterally with lateral recess decompression.
    4. Spinal osteotomy, 2 column, with mobilization for rigid adult idiopathic scoliosis, thoracic 5 to thoracic 12, and lumbar 1 to lumbar 4-5. This is 10 levels of radical facetectomy and osteotomy.
    5. Posterior spinal fusion using combination of locally harvested autogenous bone and allograft T2 to the pelvis.
    6. Intraoperative somatosensory evoked potentials and motor-evoked potentials interpretation.
    7. Intraoperative fluoroscopy.

    Post-Op Films:

    One year post-op the patient is doing very well. She is highly functional and working. The patient is happy with her symptomatic and cosmetic outcome.

    Pre-Op/Post-op Comparison: 

    The patient has improved balance in the coronal plane.
    The patient is well balanced in the sagittal plane. Her head is balanced over her hips.

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