Adult Scoliosis Case 5

Case Review #5: 43 year old woman with Adult Idiopathic Scoliosis from Robert Pashman

A 43 year old woman, presented with Adult Idiopathic Scoliosis, 50° lumbar curve. Dr. Pashman treated her with Posterior Spinal Fusion from T9 – L5. Curve was a KIM/SRP Classification 2.

    Case Review:

    Adult Idiopathic Scoliosis with a 50° Lumbar Curve

    Patient History:

    43 yo female, increasing pain over her left lumbar curve.
    She has tried chiropractic, physical therapy, massage, injections, anti-inflammatories.
    The pain is severe.
    On physical examination, she has typical right flank elevation.
    She has decompensation to the left. Sagittal plane is good.
    She has a slight right rib hump.
    36×14 x-rays show a 45° left lumbar curve which increased from 40° in 2001.
    She has rotation or lateral listhesis of L3 on 4, and is decompensated approximately 3-4 cm to the left. She has good sagittal plane.

    Bending Films:

    On bending films, she does not correct her L4 over 5, but these are not forced bending films, as far as I can say. She also has apical degeneration through the apex of the curve which is significant. This was not present on 2001 films.

    Indications for Surgery:

    50° thoracolumbar adult idiopathic scoliosis, progressive.
    Severe low back pain and radiculopathy.
    Degenerative disc disease, lumbar spine.
    Failed conservative therapy.
    Severe rotation sagittal plane deformity causing the above diagnoses.

    Surgical Strategy:

    Segmental spinal instrumentation using pedicle screw, rod construct, 5.5 stainless steel T9 to L5, eight levels.
    Posterior spinal fusion, T9 to L5, eight levels, using a combination of autogenous and BMP bone.
    Interlaminar decompression, lateral mesial facetectomy, lateral recess release, neural foraminotomy for spinal stenosis, L1-2, L2-3, L3-4, and L4-5 bilaterally.
    Spinal osteotomy for mobilization of stiff rigid posterior adult idiopathic spine, L1-2, L2-3, L3-4, and L4-5.
    Autogenous bone graft harvesting.
    Intraoperative somatosensory-evoked potentials.
    Intraoperative fluoroscopy.

    Post-Operative X-Rays:

    The patient is doing well. Hardware looks good. Balance is excellent. Two months post-op, she has minimal pain and has increased her activities.

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