Flatback Case 2

Case Review #2:66 year old female with severe Flatback Syndrome from Robert Pashman

A 66 year old female presented with severe Flat back Syndrome, Kyphosis, and critical stenosis. Dr. Pashman treated the patient with a posterior spinal fusion T2 to the pelvis. The patient was able to stand up straight following surgery.

      Case Review:

      Severe FlatbackDeformity and Kyphosis Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery

      Patient History:

      66 year old femaleSevere Flatback Syndrome65° thoracolumbar kyphosis with straightening of lumbar spinewhich accentuates her forward decompensation.Critical spinal stenosis at L3-4 lateral, lateral recess stenosis atL4-5.Sagittal plane deformity. Multiple comorbidities including type 2 diabetes, cardiacarrhythmias, status post pulmonary embolus 1997, osteoarthritis.No compression fracturesWith diagnosis of DISH syndrome with spontaneous ossificationthe anterior longitudinal ligament and multiple disk spaces, nowhas progressive kyphosis. She notices no specific trauma per se.

      Indications for Surgery:

      Severe flat back syndrome. Sagittal plane imbalance with volar decompensation.Thoracic and lumbar kyphosis.Spinal stenosis L3-4.Failed conservative therapy.

      Surgical Strategy:

      Posterior instrumented fusion with multiple-level Ponteosteotomies, a pedicle subtraction osteotomy, a L3-4saggital alignment and sacropelvic fixation. The patientknows that she may need an anterior full interbodyfusion.The patient will be admitted a couple days early to havea IVC filter placed for history of DVT.

      Surgical Procedures:

      Segmental spinal instrumentation thoracic 2 to the pelvis with 1/4-inchstainless steel rod, screw and hook construct. Sacral pelvic fixation.Posterior spinal fusion of thoracic 2 to the pelvis with iliac crest bone graftplus autologous locally harvested bone and recombinant human bonemorphogenetic protein.Kyphectomy L3 with pedicle subtraction osteotomy for increase thoraciclordosis.Laminectomy L2-3, L3-4, L4-5 for spinal stenosis.Ponte bilateral osteotomy for ankylosed spine thoracic 4, thoracic 5,thoracic 6, thoracic 7, thoracic 8, thoracic 9, thoracic 10 and thoracic 11.Intraoperative motor evoked potentials and somatosensory evokedpotentials. Intraoperative fluoroscopy. Intraoperative Mayfield pin fixation. Right iliac crest bone graft harvesting through a separate incision.Exposure of left iliac crest bone graft.

      Post-Op Films:

      At the time of operation,the patient’s spine wasseverely ankylosed andkyphotic.The patient neededsignificant mobilizationand disassembly of thespine to get into a normal sagittal balance.

      Pre-Op /Post-Op Film Comparison:

      The patient has somenominal pain. She isvery happy about herrange of motion.