39 year old female with Progressive Adult Scoliosis: Case 25

Case Review #25: 39 year old female with Progressive Adult Scoliosis from Robert Pashman

39 year old female presented with Progressive Adult Idiopathic Scoliosis. Dr. Robert Pashman treated the patient with a posterior spinal fusion from T3-L4. KIM/SRP Classification 1

    Case Review:

    39 year old female presented with Progressive Adult Idiopathic Scoliosis

    Patient History:

    39-year-old female presented with Progressive Adult Idiopathic Scoliosis.
    The patient was diagnosed with Adolescent Idiopathic Scoliosis as a teenager.
    She wore a brace 23 hours a day between ages 12 and 16 years old.
    The patient reports that the curve has progressed and she has lost height.
    She has low back thoracolumbar pain.
    No radiculopathy or lower extremity symptoms.
    On physical examination, she has a right elevation rib hump and left flank fullness.
    She has an increased lumbar-thoracic kyphosis.
    Motor and sensory examinations are intact.
    The patient has significant rotation low back pain and failed conservative therapy.

    Indications for Surgery:

    51° progressive Adult Idiopathic Scoliosis. Kim SRP type 1 curve.
    Severe degenerative disk disease at L1-2, L2-3 in the compensatory lumbar curve.
    Low back and leg pain due to the above diagnosis.
    Failed conservative therapy.
    Significant rigidity with thoracolumbar kyphosis.

    Surgical Strategy:

    1. Segmental spinal instrumentation thoracic 3 to lumbar 4 using 1/4- inch stainless steel pedicle screw rod construct.
    2. Multiple level spinal osteotomy thoracic 5 to lumbar 2 with bilateral Smith- Peterson radical facetectomy, 7 level osteotomy.
    3. Posterior instrumented fusion thoracic 3 to lumbar 4 using locally harvested autogenous bone and rhBMP.
    4. Interlaminar laminotomy, mesial facetectomy, lateral recess release under loupe magnification and high intensity illumination at L1-2, L2-3, L3-4 and T12-L1 bilaterally.
    5. Intraoperative SSEP motor evoked potentials.6. Intraoperative fluoro.

    Post-Op Films:

    The patients x-rays look excellent with good frontal plane sagittal balance.

    Pre-Op/Post-op Comparison:

    The patient is well balanced, and very happy with her outcome. She gained an inch in height after surgery.
    The patient has great posture and is doing very well.

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