Adult Idiopathic Scoliosis: Case 29

Case Review #29: 57 year old female with Adult Thorcolumber Scoliosis from Robert Pashman

57 year old female with Adult Idiopathic Scoliosis. She presented with a 62 degree thoracolumbar curve. Dr. Pashman treated the patient with a posterior spinal fusion from T10-Pelvis. Dr. Pashman took great care with incision closure to preserve the patient’s tattoo.  KIM/SRP Classification 2.

    Case Review:

    57 year old female with Adult Idiopathic Scoliosis

    Patient History:

    57 year old female
    Adult Idiopathic Scoliosis, Kim/SRP Type 3
    Patient is a weightlifter, in is in good physical shape.
    Patient reports losing height and progressive deformity.

    Pre-op X-rays:

    The patient has a 62° thoracolumbar curve, with severe degeneration of L4-5 and L5-S1 at the fractional concavity. The patient is well-balanced in the sagittal plane. The thoracolumbar curve extends past the thoracolumbar junction and down to the sacrum.

    Indications for Surgery:

    1. Kim/SRP type 3 adult idiopathic scoliosis.
    2. Severe degenerative lumbosacral oblique take-off.
    3. Coronal and sagittal plane decompensation.
    4. Unremitting low back and lower extremity radiculopathy due to the above diagnosis.
    5. Failed conservative therapy.
    6. Asthma.
    7. Osteopenia.

    Surgical Strategy:

    Abdominal retroperitoneal Segmental spinal instrumentation, T10 to approach to the lumbosacral spine sacral pelvis, using titanium pedicle screw,
    Radical diskectomy L4-5, L5-S1  5.5 rod instrumentation with epidural decompression.
    Posterior spinal fusion, T10 to the sacral
    Interbody fusion with PEEK pelvis using locally harvested autogenous device, 8 mm at L4-5, and an FRA bone and allograft PEEK measuring 11 mm at L5-S1,both with combination of allograft Smith-Peterson osteotomy for looseningand rhBMP centrally of lumbar spine, T10-11, T11- 12, T12-L1
    Anterior screw fixation, L4-5, L5- L1-2, L2-3 and L4-5.S1.
    Lateral recess decompression L3-4
    Intraoperative fluoroscopic L4-5.control.
    Intraoperative O-ARM neuronavigation with Stealth system.
    Intraoperative somatosensory evoked potentials and motor evoked potentials.
    Plastic closure of wound.

    Pre-Op/Post-op Comparison:

    The patient is perfectly balanced in the sagittal plan.

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