Adult Scoliosis Case 53

Case Review #53: 58 year old female with Adult Scoliosis and low back pain from Robert Pashman

A 58 year old female presented with severe, progressive, Lumbar Scoliosis. The patient failed conservative therapy and had unrelenting leg pain. She was treated with a posterior spinal fusion from T11-pelvis.

    Case Review:

    58 year old femle, with Adult Idiopathic Scoliosis and low back pain.

    Patient History:

    56-year-old female
    Adult Idiopathic Scoliosis
    Progression of curve
    Low back pain
    Multiple epidurals

    Pre-op X-rays:

    Approximately a 38° left lumbar curve which is highly rotated and degenerated. She has a compensatory curve of the thoracic spine which does not appear rotated, but uncommonly she has right shoulder depression which indicates that either the lumbar curve is not being compensated for or she has slight structurality of the upper thoracic curve which is small.

    Indications for Surgery:

    1. KIM/SRP type 2, severe lumbar scoliosis, idiopathic-de novo, lumbar spine progressive, 35 to 50 degrees.
    2. Severe rotation with significant degeneration and instability at L3- 4.
    3. Lumbosacral transitional vertebra with fixed lumbosacral obliquity.
    4. Thoracolumbar kyphosis with severe collapse and degeneration at L3- 4.5. Intraforaminal disk herniation L5-S1 on the right.
    6. Failed conservative therapy including back pain and radiculopathy of greater than one year.

    Surgical Strategy:

    T11 to sacral pelvis fixation with 5.5 cobalt chromium-titanium pedicle screw-rod construct.
    Multiple level spinal osteotomy for reduction of lumbar kyphosis, rotation and scoliosis, T12-L1, L1-2, L2-3 and L4-5 with bilateral radical facetectomy and subrecess Smith-Peet osteotomy.
    Posterior spinal fusion, T10 to sacral pelvis using locally harvested autogenous bone, allograft chips and RH BMP.
    Intraoperative SSEP and motor evoked potential.
    O-arm intraoperative CT navigation and use of Stealth navigation.
    Plastic closure of wound.

    Post-op Films:

    The patient is well balanced in both the sagittal and coronal plane.  She is doing great, and enjoying relief from her back pain.  She is very happy with her outcome.

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