Adult Scoliosis and Burst Fracture: Case 46

Case Review #46: 56 year old female with Adult Idiopathic Scoliosis and Burst Fracture from Robert Pashman

56 year old female with Idiopathic Scoliosis, status post burst fracture, presented with junctional kyphosis. Dr. Pashman treated the patient with a posterior spinal fusion from T2-pelvis. Spinal curvature was a KIM/SRP Classification 3.

    Case Review:

    56 year old female with Idiopathic Scoliosis, status post burst fracture, presented with thoracic kyphosis.

    Patient History:

    56-year-old female
    Status post burst fracture from an airplane crash greater than 15 years ago, pre-existing diagnosis of Idiopathic Scoliosis
    Now superimposed burst fracture caused spinal cord compression and was treated with thoraco-abdominal vertebrectomy strut grafting followed by posterior instrumentation with Cottrell Dubois instrumentation
    The patient had the instrumentation in situ but now is developing a thoracic kyphosis, subjacent degeneration with forward and coronal plane decompensation causing significant pain, radicular and low back.
    Failed conservative therapy.

    Indications for Surgery:

    1. Status post burst fracture, thoracolumbar junction.
    2. Status post anterior spinal fusion with vertebrectomy strut graft, T11-L1.
    3. Status post posterior instrumented fusion with CD (Cottrell Dubois) hook rod construct thoracolumbar spine.
    4. History of adolescent/adult idiopathic scoliosis.
    5. Now with proximal junctional kyphosis and subjacent degeneration with coronal and sagittal plane decompensation.
    6. Low back radicular pain, failed conservative therapy.
    7. Co-morbidity of von Willebrands disease.

    Surgical Strategy:

    Segmental spinal instrumentation, thoracic to sacral pelvis. This is an 18 level segmental spinal instrumentation using stainless steel 5.5 pedicle screw rod construct with sacral pelvic fixation.
    Posterior spinal fusion, T2 to sacral pelvis using locally harvested autogenous bone in RH BMP.
    Multilevel Smith-Peterson osteotomy, T4 to L4. This is a 16 level Smith-Peterson osteotomy for mobilization of the spine for posterior base only, coronal and sagittal plane correction.
    Laminectomy, L1 to L4, for decompression and mobilization of subjacent spine with Smith-Peterson osteotomy under the microscope loupe magnification.
    Intraoperative SSEPs.
    Intraoperative fluoroscopy.

    Post-op Films:

    The patient is well balanced in the coronal and sagittal planes.


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