Kyphosis Case 4

Case Review 4: A 58 year old female presented with Scheurmann's Kyphosis from Robert Pashman

A 58 year old female presented with severe Scheurmann’s Kyphosis. Dr. Pashman treated the patient with a posterior spinal fusion from T2-Pelvis.

Patient History:

58 year old female. Severe rigid thoracolumbar kyphosis probably due to Scheuermann kyphosis with superimposed degeneration. This has caused a rigid sagittal plane deformity. The hyperlordosis in the dorsal spine has caused a significant neural foraminal stenosis degeneration. Failed conservative therapy

Flex/ Extension X-ray:

The flexion and extension films show the rigidity of the spine.

Indications for Surgery:

1. Scheuermann kyphosis thoracolumbar spine
2. Severe superimposed degeneration of thoracolumbar spine due to sagittal deformity
3. Scoliosis
4. Compensatory hyperlordosis of lumbar spine causing severe neural foraminal stenosis of thoracolumbar spine.
5. Failed conservative therapy.
6. Multiple co-morbidities including age, cachexia
7. Rigid thoracolumbar kyphosis

Surgical Strategy:

Segmental spine instrumentation, thoracic 2 to sacral pelvis. This is an 18-level posterior instrumental fusion using CD 1/4-inch stainless steel rod screw construct. Bilateral pelvic exposures through separate incisions for placement of pelvic instrumentation. Interlaminar laminotomy, mesial facetectomy, lateral recess release decompression, L1-2, 2-3, 3-4, 4-5, 5-1 for severe lateral recess and foraminal stenosis. Smith-Peterson osteotomy through laminectomies and bilateral radial facetectomies, T9-10, T10-11, T11-12, T12-L1, L1-2, L2-3, L3-4, and L4-5. Posterior lateral fusion using locally harvested autogenous bone, T10, T2 down to the sacral pelvis. Intraoperative somatosensory evoked potential monitoring. Intraoperative fluroscopy management.

Post-Op Firms:

The patient plumb lines perfectly in both the sagittal and coronal planes.

Pre-Op/ Post-op Comparison:

The patient had a complete correction of her curvature, and gained 2 inches in height.