Adult Scoliosis Case 28

Case Review #28: Patient with Lumbar Scoliosis status post surgery with Harrington Rods from Robert Pashman

A 37 year old female presented status post posterior spinal fusion for Adolescent Idiopathic Scoliosis. She had Harrington Rods and the lumbar curve continued to progress, requiring surgical intervention.

    Case Review:

    37 Year old female, withHarrington Rods and progressive lumbar curvature.

    Pre-op X-rays:

    37-year-old female Status post posterior instrumented fusion with single TSRH rod due to concavity for selective thoracic fusion Adolescent Idiopathic Scoliosis. The patient has a true double major curve which would be classified as 3C as an adolescent, which was not instrumented. The lumbar curve is significantly rotated and degenerated, was left to progress causing the patient to have subjacent degeneration and severe pain.

    Indications for Surgery:

    1. Status post posterior selective thoracic fusion for Adolescent Idiopathic Scoliosis, now has KIM/SRP type 3 subjacent degeneration and progressive curvature, lumbar spine.
    2. Congenital component L5-S1 with degeneration at L4-5, L5-S1, preoperative for stage II KIM/SRP adult idiopathic scoliosis.
    3. Unremitting low back pain due to subjacent degeneration and progressive lumbar curvature, status post posterior instrumented fusion.
    4. Radiculopathy due to the above diagnoses.

    Surgical Strategy:

    Abdominal retroperitoneal approach to lumbosacral spine.
    Radical diskectomy of L4-5, L5-S1 with epidural decompression.
    Interbody fusion using PEAK device, FRA 13 mm and 11 mmwith rhBMP respectively.
    Anterior screw fixation L4-5, L5-S1 using fully threaded screwover washer for buttress plate, for buttress of interbody grafts.
    Intraoperative SSEPS.
    Intraoperative fluoro management.
    T2 to pelvis segmental spinal instrumentation using 1/4 inch stainless steel screw/rod construct.
    Multiple level osteotomy T12-L1, L1-L2, L2-L3 for induction of subadjacent junctional kyphosis through Smith-Petersen osteotomies.

    Surgical Strategy, cont:

    Re-exploration and decompression junctional area for previous stenosis in the T12 to L1 area, status post hook removal.
    Removal of retained TSRH single rod Harrington sublaminar wire construct.
    Osteotomy T4 to T8 for removal of fusion mass overlying buried retained hardware.
    Separate incision iliac crest bone graft left with placement of pelvic screw.
    Intraoperative O-arm neuro navigation management.
    Intraoperative x-ray management.
    Plastic closure.
    Repeat thoracoplasty chest wall reduction, T5-T6, T7-T8 with transverse process osteotomy.
    Motor evoked potential management.

    Post-Op Films:

    The patient is balanced in both the saggital and coronal planes.  She is very happy with her cosmetic outcome.

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