Adult Idiopathic Scoliosis 58° lumbar curvature: Case 47

Case Review #47: 20 year old female with Adult Idiopathic Scoliosis from Robert Pashman

A 20 year old female from Mexico presented with 58 degree lumbar scoliosis. She was diagnosed at age 14, and was not prescribed a TLSO brace. Dr. Pashman performed a posterior spinal fusion on the patient.

    Case Review:

    20 year old female with Adult Idiopathic Scoliosis, 58° lumbar curvature, traveled from Mexico for surgical treatment.

    Patient History:

    A 20-year-old female
    Diagnosed with Adolescent Idiopathic Scoliosis at age 14
    Traveled from Mexico for treatment.
    No bracing as a child/teenager
    2 cm right rib flank fullness
    Intermittent back pain
    Tried conservative treatment including: traction, acupuncture, and chiropractic.

    Pre-op X-rays:

    There is a sharp angular 58° lumbar curve apex at L2-3 to the right. The patient is decompensated approximately 1-2 cm to the right. The patient has a significant rotation angulation at L3-4.

    Bending X-rays:

    The patients left side bending corrects to 8°, but still off midline. Right bending goes down to 38°. Right and left side bending films reveal moderate flexibility of the lumbar curve but increased correction on left side bending of L4 to S1.

    Indications for Surgery:

    1. Kim/SRP type 1, King type 5 lumbar adult idiopathic scoliosis 58 degrees.
    2. Thoracolumbar kyphosis due to #1.
    3. Low back pain.
    4. Failed conservative therapy.

    Surgical Strategy:

    Segmental spinal instrumentation T11 to L4 using 1/4-inch stainless steel pedicle screw rod construct.
    Posterior spinal fusion T11 to L4 using combination of autogenous allo and RH BMP bone T11 to L4.
    Multiple level Smith-Petersen osteotomy for induction of flexibility of thoracolumbar kyphosis and stiff lumbar curve.
    Intraoperative O-Arm neuronavigation management.

    Post-op Films:

    The patient is well balanced in the sagittal and coronal planes. Her curve was reduced from 58° to 22°. The patient returned to Mexico approximately 2 weeks following surgery, and then sent post-operative x-rays for review.

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