56 year old female with Idiopathic Scoliosis, status post burst fracture, presented with junctional kyphosis. Dr. Pashman treated the patient with a posterior spinal fusion from T2-pelvis. Spinal curvature was a KIM/SRP Classification 3.

1. Case Review:
56 year old female with
Idiopathic Scoliosis,
status post burst fracture,
presented with thoracic
kyphosis.
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 56-year-old female
• Status post burst fracture from an airplane crash greater than 15
years ago, pre-existing diagnosis of Idiopathic Scoliosis
• Now superimposed burst fracture caused spinal cord compression
and was treated with thoraco-abdominal vertebrectomy strut
grafting followed by posterior instrumentation with Cottrell
Dubois instrumentation
• The patient had the instrumentation in situ but now is developing
a thoracic kyphosis, subjacent degeneration with forward and
coronal plane decompensation causing significant pain, radicular
and low back.
• Failed conservative therapy.

3. Pre-op X-rays

4. Indications for Surgery
1. Status post burst fracture, thoracolumbar junction.
2. Status post anterior spinal fusion with vertebrectomy strut graft,
T11-L1.
3. Status post posterior instrumented fusion with CD (Cottrell
Dubois) hook rod construct thoracolumbar spine.
4. History of adolescent/adult idiopathic scoliosis.
5. Now with proximal junctional kyphosis and subjacent
degeneration with coronal and sagittal plane decompensation.
6. Low back radicular pain, failed conservative therapy.
7. Co-morbidity of von Willebrand's disease.

5. Surgical Strategy
• Segmental spinal instrumentation, thoracic to sacral pelvis. This is
an 18 level segmental spinal instrumentation using stainless steel
5.5 pedicle screw rod construct with sacral pelvic fixation.
• Posterior spinal fusion, T2 to sacral pelvis using locally harvested
autogenous bone in RH BMP.
• Multilevel Smith-Peterson osteotomy, T4 to L4. This is a 16 level
Smith-Peterson osteotomy for mobilization of the spine for
posterior base only, coronal and sagittal plane correction.
• Laminectomy, L1 to L4, for decompression and mobilization of
subjacent spine with Smith-Peterson osteotomy under the
microscope loupe magnification.
• Intraoperative SSEPs.
• Intraoperative fluoroscopy.

6. Post-op Films
The patient is well
balanced in the coronal
and sagittal planes.

7. Pre-Op/Post-op Comparison