Adult Scoliosis with Flatback and Spondylolisthesis: Case 3

Case Review #3: 65 year old woman with 55 degree Thoracolumbar Scoliosis from Robert Pashman

A 65 year old female with a 55° thoracolumbar curve, spondylolisthesis, and flatback syndrome. Treated with an Anterior/Posterior Spinal Fusion. KIM/SRP Classification 3.

    Case Review:

    Adult Idiopathic Scoliosis treated with ASF/PSF

    Patient History:

    65 year old female with Adult Idiopathic Scoliosis
    Progressive thoracic curve
    Secondary diagnosis: – Isthmic Spondylolisthesis, L5/S1, Grade I – Sagittal plane deformity with Flatback Syndrome
    Status post C7-T1 removal of facet cyst
    Severe low back and leg pain
    Failed conservative therapy

    Pre-Operative X-Rays:

    The patient is decompensated to the left and forward, as shown with plumb line.

    Surgical Strategy:

    1. Segmental spinal instrumentation for correction of adultidiopathic scoliosis T2 to sacropelvis pelvic fixation, that is 17-18 level fusion using Cotrel-Dubousset 5-5 thoracic quarter inch stainless steel lumbar with sacropelvic fixation.
    2. Posterior spinal fusion T2 to sacropelvis with combination ofautogenous harvested bone and RHBMP.
    3. Interlaminar laminotomy, mesial facetectomy, lateral recess release for re-exploration decompression L1-2, L2-3, L3-4, L4-5 and L5-S1 bilaterally.
    4. Intraoperative SSEPs.
    5. Intraoperative fluoro using iso-C navigation and fluoro.
    6. Plastic closure of wound.

    Post-Operative X-rays:

    Results 37% correction of was obtained. Her sagittal balance is perfect, all of the patient’s symptoms have resolved.
    The patient’s sagittal plane balance was restored.At one year post-op, the patient had no radiculopathy, no pain, and no complaints.

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