Kyphosis Case 8

Case Review #8: A 29 year old female firefigher presented with Scheurmanns Kyphosis from Robert Pashman

A 29 year old female firefighter, diagnosed with progressive Scheurmann’s Kyphosis. She presented status post surgery T12-L1 for trauma. Dr. Pashman treated the patient with a Posterior Spinal Fusion from T2 to L2.

    Case Review:

    29 year old female firefighter, with progressive Schuermann’s Kyphosis, status post spinal fusion from T12-L1

    Patient History:

    29-year-old female Status post a thoracoabdominal approach and interbody fusion of T12-L1 for diskogenic disease, positive diskogram, and thoracolumbar degeneration and pain status post trauma. Patient is a fire fighter by occupation. Now she is found to have progressive Scheuermanns kyphosis measuring 75° of the thoracic spine. The patient has failed conservative therapy.

    Pre-op X-rays

    Classic Scheuermanns identified with multiple-level vertebral body wedging and degeneration of the thoracic spine causing severe upper mid-scapular pain with radiation to the thoracic, thoracolumbar, and cervical spine.

    Indications for Surgery:

    1. A 75° progressive Scheuermanns kyphosis of thoracic spine.
    2. Status post abdominal retroperitoneal approach and interbody fusion, T12-L1.
    3. Now with increasing low back pain due to hyperlordosis cervical, hyperlordosis lumbar and progressive thoracic kyphosis.
    4. Failed conservative therapy with physical therapy and medication treatment.
    5. Multiple-level degenerative disk disease of thoracolumbar spine due to Scheuermanns kyphosis.

    Surgical Strategy:

    Thoracic 2 to lumbar 2 segmental spinal instrumentation using titanium cobalt chromium pedicle screw 5.5 rod construct. Multiple-level Smith-Petersen osteotomy for mobilization of a rigid Scheuermanns kyphosis at T3-T4, T4-T5, T5-T6, T6-T7, T7-T8, T8-T9, T10-T11, and T12-L1. Posterior spinal fusion using locally harvested autogenous bone and allograft, T2-L1. Multiple-level facetectomy for mobilization of thoracic spine T3- L1. Intraoperative neuronavigation using O-ARM Treon S7 Stealth device. Intraoperative motor evoked potential monitoring. Plastic closure of wound.

    Post-op Films:

    The curvature was reduced from 75° to 30° while maintaining the coronal and sagittal balance.