Male with Adult Scoliosis and Junctional Kyphosis: Case 45

Case Review #45: 35 year old male with Junctional Kyphosis from Robert Pashman

35 year old male status post T4-L1 fusion for Adult Idiopathic Scoliosis, presented with junctional kyphosis. The patient was treated with a posterior spinal fusion from T2-L4. KIM/SRP Classification 1.

    Case Review:

    35 year old male, status post T4-L1 fusion for Adult Idiopathic Scoliosis presented with junctional kyphosis.

    Patient History:

    35-year-old male
    Status post T4-L1 fusion for Adult Idiopathic Scoliosis.
    The patients construct is a Harrington Luque Wisconsin wire construct with onlay of bone graft.
    Over the years, the patient had, because of some element of sagittal plane decompensation, significant junctional kyphosis, L1-2, L2-3, and L4, with severe retrolisthesis L2-3, L3-4 due to attempt to compensate for the thoracolumbar kyphosis. This led to severe pain.

    Pre-op X-rays:

    Preoperative scanning showed severe degeneration subadjacent to the previous fusion and superadjacent to the previous fusion. The patient had element of coronal plane decompensation, also. He failed conservative therapy

    Indications for Surgery:

    1. Adult idiopathic scoliosis, KIM/SRP type 1 curve.
    2. Status post posterior instrument fusion for adolescent idiopathic scoliosis.
    3. Now with junctional kyphosis subadjacent to previous fusion with severe degeneration L1-2, L2-3, and L3-4.
    4. Sagittal coronal plane decompensation.
    5. Possible pseudoarthrosis.
    6. Superadjacent degeneration and junctional kyphosis T2, T3.
    7. Failed conservative therapy.

    Surgical Strategy:

    Segmental spinal instrumentation thoracic 2 to lumbar 4 using pedicle screw, cobalt chromium rod construct.
    Posterior spinal fusion, T2-L4 using locally harvested autogenous bone RHBNP and allograft putty.
    Spinal osteotomy for correction of junctional kyphosis, T12-L1, L1- L2, L2-L3, and L4. 4. Superadjacent osteotomy for correction of junctional kyphosis T3- T4.
    Intraoperative neuronavigation using O-Arm Stealth construct.
    Intraoperative SSEP motor-evoked potentials.
    Removal of retained hardware, a Luque Harrington Wisconsin wire construct.

    Post-op Films:

    The patient is well balanced in both the sagittal and coronal planes.
    The patient is very happy with his outcome. He and his wife  recently had a son, and his goal for surgery was to be an active father.

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