Case Review #6: 53 year old woman with Adult Scoliosis


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A 53 year old woman, with an 85° thoracic curve, and a 75° lumbar curve. Dr. Pashman treated her with an Anterior fusion followed by a Posterior Spinal Fusion from T1 to the Pelvis. Curve was a KIM/SRP Classification 3.

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Case Review #6: 53 year old woman with Adult Scoliosis

  1. 1. Case Review: Adult idiopathic Scoliosis85˚ 75˚ double major curve with significant rotation 75˚ Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery
  2. 2. Patient History53 year old femalePresented with 85˚ thoracic and 75˚ lumbar curvatureRight thoracic/left lumbar curve with flank rotation, asmall rib hump. She is well balanced on frontal andsagittal plane, has significant asymmetric skin folds buther shoulders and pelvis appear balanced. She is ingood health and is very lean.Right leg painSpinal Stenosis and Facet dislocation at L4/5Failed conservative therapy
  3. 3. Pre-op X-rays The patient has a well documented history of85˚ scoliosis progression, and has obtained several opinions about the treatment options. 75˚
  4. 4. Bending X-raysL R
  5. 5. Bending FilmsL R
  6. 6. Indications for SurgerySevere low back pain and radicular pain75˚ adult idiopathic scoliosis, double major curve, withsignificant rotation.Degenerative disc disease, L4-5 and L5-S1.Lateral recess stenosis, and instability lumbar spine.Failed conservative therapy.
  7. 7. Surgical StrategySTAGE 1 Radical diskectomy with epidural decompression, L4-5 and L5-S1. Subtotal vertebrectomy for placement of screw fixation, L5. Anterior interbody fusion with FRA device and putty graft, L5-S1 and L4-5, Anterior screw fixation, L4-5 and L5-S.STAGE 2 Segmental spinal instrumentation using 5.5 stainless steel Legacy thoracic tented pelvis. This is an 8-level fusion. Sacral pelvic fixation with bilateral exposure of the iliac crest. Posterior spinal fusion T10 to the pelvis using locally harvested autogenous bone. 7-level osteotomy through ankylosed spine, Smith-Peterson osteotomy T11 to the sacrum. Subtotal laminectomy T12 to L5.STAGE 3 T2 to L2 12-level segmented spinal instrumentation Posterior spinal fusion, T2 to L2, using locally harvested autogenous bone and rhBMP. Spinal osteotomy, T4-T5, T5-T6, T6-T7, T7-T8, T9-T10, and T11-T12 for rigid adult idiopathic scoliosis. These are Smith-Peterson osteotomies through ankylosed and rigid spine.
  8. 8. Findings during surgeryAt the time of operation, severe rigidity ankylosingespecially in the concave side of the spine. Each jointwas fused, this in the concavity from L1 to L5 with thejoints ankylosed, a few solid to the pars, through bigdegenerative changes. This required multiple levelosteotomy as indicated in the procedure section. Thepatient was mobilized after that. The surgery tooksignificantly longer than expected because of the needfor multiple level surgery and therefore the third stagewill be completed on an interval basis.
  9. 9. Post-Op Films X-rays show excellent balance in frontal and sagittal plane, good correction of the curve. All the instrumentation looks intact.
  10. 10. Pre-Op/Post-op Comparison The patient has no post-operative radiculopathy, and minimal pain. She is not taking pain medication. Overall, she is doing quite well.
  11. 11. Pre-Op/Post-op Comparison