Adult Scoliosis Case 41

Case Review #41: 35 year old female with a 92 degree Scoliosis from Robert Pashman

A 35 year old female presented with Adult Idiopathic Scoliosis. Her thoracic curvature measured 92 degrees. The patient was experiencing upper and lower back pain. Dr. Pashman performed a posterior spinal fusion on the patient.

    Case Review:

    35 year old female with Progressive Adult  Idiopathic Scoliosis Thoracic curve measuring 92°

    Patient History:

    35-year-old female
    Progressive Kim/SRP type I Adult Idiopathic Scoliosis
    Major thoracic curve measuring in excess of 92° degrees
    Significant rotation and  deformity.
    Upper and lower back pain.

    Bending X-rays:

    Bending films show neutralization and middle stable Harrington, plumb line S1-L4.

    Indications for Surgery:

    1. Progressive adult idiopathic scoliosis, Kim / Sagittal Reconstruction Parameters type I, 5490 for 38° progressive curvature with rotation deformity.
    2. Significant upper back and low back pain due to progressive deformity.
    3. Failed conservative therapy.

    Surgical Strategy:

    Segmental spinal instrumentation thoracic 3 to lumbar 3 using 1/4- inch stainless steel pedicle screw rod construct.
    Posterior spinal fusion using locally harvested autogenous bone Rh bone morphogenic protein and extender T3 to L3.
    Multiple level spinal osteotomy through ankylosed concave, convex spine for inducement of flexibility thoracic 5-6, thoracic 6-7, thoracic 8-9, thoracic 9-10 and thoracic 11-12.
    Interlaminar laminectomy, mesial facetectomy and lateral recess release for lateral recess stenosis and pedicle visualization lumbar 1-2 and lumbar 2-3 bilaterally.
    Motor evoked potentials.
    Intraoperative fluoroscopic control.
    O arm CT intraoperative interpretation and neuronavigation guidance thoracic spine.

    Post-op Films:

    The patient is well balanced in both the sagittal and coronal planes.
    The patient’s main curve was reduced from 92° to 55°.
    She gained almost 2 inches in height, and has minimal pain.


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