Adult Scoliosis Case 34

Case Review #34: 44 Year Old Woman with Adult Idiopathic Scoliosis from Robert Pashman

A 44 year old woman presented with Adult Idiopathic Scoliosis. She wore a brace as a child, and the curvature progressed to the point she required surgery.

    Case Review:

    44 year old woman with Adult Idiopathic Scoliosis;treated with T3-L3 PosteriorSpinal Fusion

    Patient History:

    44-year-old female
    Has known adolescent scoliosis, progressing to adult idiopathic scoliosis.
    She was braced as a child with Milwaukee brace and has been followed since that time.
    She has significant pain in the shoulders, upper arms and back.  This is due to fatigue and from the collapsing curvature. She does not have any sciatica or low lumbosacral pain, but has some neck pain, without radiculopathy.
    She has tried physical therapy and conservative measures.On physical examination, she has 2-cm right rib hump, withdefinite right thoracic fullness. She has some slight proximaljunctional cervicothoracic kyphosis.

    Pre-op X-rays:

    Her 36-x-14 x-rays show a 53° right thoracic curve, with minimal lumbar component. She has depression of the left shoulder.

    Indications for Surgery:

    Progressive adult idiopathic scoliosis, thoracic spine, 53°.
    Increasing disability with thoracic and lumbar pain due to degeneration superimposed on progressive scoliosis.
    Frontal and sagittal plane imbalance.
    Rigid thoracic curve, necessitating osteotomy for inducement of flexibility.
    Failed conservative therapy.

    Surgical Strategy:

    Thoracic 3 to lumbar 3 segmental spinal instrumentation using 5.5 stainless steel pedicle screw-rod construct.
    Posterior spinal fusion, thoracic 3 to lumbar 3, using locally harvested autogenous bone and allograft extracting extender.
    Multiple-level osteotomy, T5-6, 6-7, 7-8, 8-9, 9-10, 11-12, 12-1,1- 2, and 2-3, 8-level osteotomy for inducing flexibility Smith-Peterson or Ponte osteotomy of thoracolumbar spine.
    Interlaminar laminotomy and mesial facetectomy and lateral recess release, T12-L1, L1-L2, L2-L3 bilaterally, for decompression of neural foraminal and lateral recess stenosis,lumbar spine, under the microscope.
    Motor evoked potentials.
    Intraoperative fluoroscopy.
    Interlaminar decompression with take down to midline lateral recess decompression, T5-6, 6-7, 7-8, 8-9, 9-10, 11-12.

    Post-Op Films:

    The patient is well balanced in both the sagittal and coronal planes, with instrumentation in place. She is 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