Case Review #51: 59 year old Female with Collapsing Scoliosis
Case Review: 59 year old female with60° collapsing and painful Adult Idiopathic Scoliosis 60° Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
Patient History• 59-year-old female with a• 60-degree thoracic, 60-degree lumbar KIM/SRP type 3 curve with significant 30- degree thoracolumbar kyphosis making this a KIM 3 classification.• The patient has failed conservative therapy.• The curve is collapsing and progressive and is painful.
Pre-op X-rays KIM/SRP type 3 curve that is measuring 60 degree thoracic, 60 degree lumbar with60° significant rotation lumbar, and at least a 30-degree thoracolumbar 60° kyphosis.
Indications for Surgery1. KIM/SRP type 3 adult idiopathic scoliosis with greater than 50 degrees thoracolumbar curvature.2. Thoracolumbar kyphosis with significant degeneration greater than 20 cm, greater than 30 degrees thoracolumbar kyphosis.3. Severe low back pain and radicular symptoms due to 60 degrees thoracic, 60 degrees lumbar KIM/SRP type 3 adult idiopathic scoliosis and rotation.4. Failed conservative therapy.
Surgical Strategy – part 1• Abdominal retroperitoneal approach to lumbosacral spine.• Radical diskectomy L5-S1.• Interbody fusion with polyetheretherketone device, 10-mm medium with rhBMP centrally.• Anterior screw fixation L5-S1.• Intraoperative somatosensory evoked potentials.• Intraoperative fluoroscopy.
Surgical Strategy – part 2• Thoracic 3 to sacral pelvic segmental spinal instrumentation using 1/4-inch stainless steel screw-rod complex.• Posterior spinal fusion T3 to sacral pelvis using locally harvested autogenous bone mixed with cancellus allograft in the bone mill.• Multiple level Smith-Petersen osteotomy at T10-11, T11-12, T12-1, T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, as well as T5-T6, T6-T7, T8-T9 and T10-T11.• Intraoperative O-arm neuro navigation.• Intraoperative SSEP motor evoked potential evaluation.