Flatback Case 4

Case Review #4: 58 year old male with Lumbar Scoliosis and Flatback Syndrome from Robert Pashman

A 58 year old male presented to Dr. Pashman with lumbar scoliosis, severe kyphosis, and spinal stenosis. Dr. Pashman treated the patient with a Posterior Spinal Fusion from T10-Pelvis.

    Case Review:

    Spinal Reconstruction with a Pedicle Subtraction Osteotomyfor Lumbar ScoliosisRobert S Pashman, MD Scoliosis and Spinal Deformity Surgery

    Patient History:

    58-year-old malePatient presented with Scoliosis, with significant rotation and severe lumbarkyphosis.The initial deformity may have been set up by lumbosacral transitionalvertebrae with apical wedging at the lumbosacral junction causing obliquetake off and lumbar kyphosis with degeneration.Critical spinal stenosis from L3 to L5, neurogenic claudication. This isdynamic claudication and leg pain.

    Pre-op X-rays:

    The patient has a significant lumbar deformity, with lumbar rotation and kyphosis. These have left him off balance. A minimally invasive procedure or a laminectomy would destabilize his spine, and if a minimally invasive procedure was performed, he would require further surgery down the road.

    Indications for Surgery:

    Severe spinal deformity with lumbar kyphosis.Spinal deformity with lumbar scoliosis.Critical spinal stenosis, L3-4, L4-5 and L5-S1 with neurogenic claudication. Lumbosacral anomaly with possible hemi-vertebrae formation. Significant to low back and leg pain. Failed conservative therapy.

    Surgical Strategy:

    Segmental spinal instrumentation, T10 to sacral pelvis, that is an 8-levelfusion.Segmental spinal instrumentation using 5.5 stainless steel screw rodconstruct.Posterior spinal fusion T10 to sacral pelvis using locally harvestedautogenous bone.Spinal osteotomy T11-12, T12-L1 and L1-2 for reconstitution ofthoracolumbar lordosis. Complete laminectomy of L3 to L5 for spinal stenosis and mobilization forPSO. Spinal kyphectomy L3 for realignment of lumbar kyphosis. Intraoperative SSEP.Intraoperative fluoroscopic interpretation. Interlaminar decompression L5-S1 bilaterally.

    Post-Op Films:

    The patient is doing well post-operatively. He will visit the clinic where x-rays will be taken on a scheduled basis. At one year post-op the fusion should be complete.

    Pre-Op/Post-op Comparison:

    The spinal curvature was corrected and stabilized in both the frontal and sagittal planes with this procedure.

    The patient’s spinal balance has been restored. As you can see on the left (pre-op) X-ray, his head was not balanced over his hips; he was decompensated in a forward position. This was corrected with the surgery.