Kyphosis Case 5

Case Review #5: 48 year old male with Scheurmann's Kyphosis from Robert Pashman

A 48 year old male with rigid Scheurmann’s Kyphosis. Dr. Pashman treated the patient with a Posterior Spinal Fusion from T2-L4.

    Case Review:

    Rigid Scheurmann’s Kyphosis Treated with a Posterior Spinal Fusion from T2-L4.

    Patient History:

    48-year-old Egyptian man Rigid thick type 2 Scheuermann kyphosis of the thoracolumbar spine measuring 70°.The patient has hypercompensatory lordosis, thoracichyper compensatory lordosis of lumbar spine, both causing significant symptoms referable to this area.The hyperlordosis of the lumbar spine causes significant foraminal stenosis as the spine is drawn into compression.This all needed to be decompressed.

    Indications for Surgery:

    1. Rigid Scheuermann kyphosis thoracolumbar type 2, 70-degree fixed apical T10 abnormality.
    2. Incidental scoliosis thoracolumbar spine.
    3. Severe low back pain and radiculopathy due to kyphosis and compensatory hyperlordosis of lumbar spine.
    4. Multiple co-morbidities including type 2 diabetes and chronic smoking.
    5. Now with inability to function due to pain and chronic congestion due to smoking and pulmonary compression, status post cardiac stent.

    Surgical Strategy:

    Thoracic 2 to lumbar 4 posterior instrumented fusion with 1/4-inchstainless steel Legacy pedicle screw rod construction, this is 16levels.Posterior spinal fusion T2 to L4. This is a 16 level posterior spinalfusion with the combination of locally harvested autogenous boneand Rh bone morphogenic protein.Spinal osteotomy Smith-P/Ponte radical facetectomy for posteriorrelease of thoracolumbar spine T7-8, T8-9, T9-10, T10-11, T11-12and L1-L2. This is a 6 level osteotomy.Subtotal laminectomy for decompression of spinal cord overkyphotic segments T7-8 to L1-2. This is a 6 level spinaldecompression with the microscope.Interlaminar laminotomy, mesial facetectomy, lateral release forspinal stenosis due to hyperlordotic compensatory lumbar spine L1-2, L2-3, L3-4, L4-5, all under the microscope.Motor evoked potentials, somatosensory evoked potentials.Intraoperative fluoroscopy.

    Post-Op Films:

    The patient is well balanced in both the sagittal and coronal planes.