Case Review #4: 31 year old woman with Adult Idiopathic Scoliosis

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A 31 year old woman, with Adult Idiopathic Scoliosis, 75° stiff lumbar curve, rotated 90°. Dr. Pashman treated the patient with and Anterior Spinal Fusion followed by a Posterior Spinal Fusion. KIM/SRP Classification 2.

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Case Review #4: 31 year old woman with Adult Idiopathic Scoliosis

  1. 1. Adult Idiopathic Scoliosis with Lumbosacral Kyphosis:Treated with Anterior and Posterior Spinal Fusion Robert S. Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
  2. 2. Patient History• 31 Year old female• Diagnosis: Progressive Adult Idiopathic Scoliosis with Lumbosacral Kyphosis• Patient diagnosed at age 12, did not wear her brace• Four inch height loss• Low back pain, leg pain• Failed to respond to conservative therapy
  3. 3. Pre-Operative X-Rays • 75° curvature of the lumbar spine, rotated approximately 90° • 2 cm decompensation75°
  4. 4. L RBending X-rays: The patient has a very stiff lumbar obliquity thatdoes not correct on right or left side bending.
  5. 5. Surgical Strategy • Radical discectomy of T10-L1 (7 levels) • Anterior interbody fusion L4-S1, using PEAK and autogenous rib bone graft T10 • Anterior interbody fusion T10-L4 L1 using morselized bone graft L4 • Posterior Spinal Fusion T10 to S1 Sacral PelvisPelvis
  6. 6. ResultsThe original surgical planwas to fuse T10 to S1.Spinal balance wasachieved by T12, thereforetwo levels were spared.
  7. 7. Pre-Op/ Post-op Comparison A correction of 57% was obtained. The lumbar kyphosis has been corrected in the75° 32° frontal plain.
  8. 8. Thoracic kyphosis corrected. The pre- operative pain thatshe was experiencing in her back and legs has significantly decreased, and sherequires minimal pain medication. The patient is quite pleased with her appearance.

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