Kyphosis Case 9

Case Review #9: 19 year old female with Scheuermann's Disease from Robert Pashman

A 19 year old female from Las Vegas traveled to Los Angeles for treatment. She presented with progressive Scheurmann’s Kyphosis. The patient is an equestrian rider and model. Dr. Pashman treated the patient with a Posterior Spinal Fusion from T3 to L1. She returned to modeling a few months post-op, and returned to horseback riding at 6 months post-op.

    Case Review:

    19 Year Old Female75° with progressive Scheurmann’s Kyphosis

    Patient History:

    75 degree progressive Scheuermann kyphosis which is rigid. The patient has significant cosmetic structural deformity but more importantly has pain related to her neck and low back at the compensatory curves. The curve is progressive. The patient has difficulty with sagittal balance issues• Failed conservative therapy. There is some depression of her right shoulder. She has an elevation of her thoracic ribs on the right-hand side, but has a significant fixed kyphosis of the thoracic spine. This is associated with hyper lordosis of the lumbar spine.

    Pre-op X-rays:

    The diagnosis was made by 3 contiguous mid-thoracic vertebrae which have greater than 5° of wedging and have significant degenerative disk disease between them indicating apophyseal shutdown at some point in her development. The 15° scoliosis is a red herring. She has hyper lordosis.

    Indications for Surgery:

    1. 75 degree structural and rigid Scheuermann’s kyphosis, thoracic spine.
    2. Hyper compensatory lumbar lordosis with similar low back pain due to Scheuermann’s kyphosis.
    3. Failure of conservative therapy including bracing, physical therapy and medicines.
    4. Now with progressive deformity causing significant global imbalance and pain with element of a small 15 degree scoliosis.

    Surgical Strategy:

    Segmental spinal instrumentation thoracic 3 to lumbar 1 using quarter-inch stainless steel pedicle screw rod construct. Posterior spinal fusion from T3-L1 using locally harvested autogenous bone and allograft. Multiple level spinal osteotomy for induction of flexibility of rigid Scheuermann’s Kyphosis, Smith-Petersen osteotomies at T4-5, T5- 6, T6-7, T7-8, T8-9, T10-11, T11-12. Intraoperative neuro-navigation using O-arm and C-arm management.• Intraoperative somatosensory evoked potential.

    Post-op Films:

    The patient is well balanced in both the sagittal and coronal plane. She returned to modeling post-operatively, and plans on returning to equestrian training.