This case review summarizes the surgical treatment of a 64-year-old female patient with degenerative lumbar scoliosis, spondylolisthesis, and flatback syndrome. She presented with a 28 degree lumbar curvature, flatback deformity, and spondylolisthesis. Her condition caused severe pain and disability. The surgical strategy involved segmental spinal instrumentation from L1 to the sacrum, posterior spinal fusion from L1 to S1, osteotomies from L1 to S1 to correct the deformity, and decompression of spinal stenosis. Post-operatively, her X-rays showed excellent alignment and core exercises provided pain relief, allowing for improved function.

1. Case Review:
Degenerative Lumbar Scoliosis,
with Spondylolisthesis and
Flatback Syndrome
28°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
64-year-old female
Degenerative spondylolisthesis and scoliosis
Status post anterior spinal fusion
Flat back deformity, coronal and sagittal plane imbalance,
Severe stenosis, lateral recess stenosis, L3-4 and 4-5, lateral
listhesis, incapacitated with pain, narcotic addiction and
obesity.
The patient, at this point, needs reconstruction for
mobilization. This has to do with quality of life issues. The
patient is unable to ambulate at this point.

3. Pre-op X-rays
The patient has multiple
problems to be addressed.
She has a lumbar curvature
of 28°, Flatback Syndrome,
28° and Spondylolisthesis.

4. Indications for Surgery
1. Degenerative spondylolisthesis, L4-5.
2. Critical spinal stenosis, L3-4 and 4-5.
3. Degenerative scoliosis of the lumbar spine.
4. Severe facet arthropathy, causing low back pain, leg pain, lumbar spine.
5. Failed conservative therapy.
6. Multiple comorbidities, including obesity and narcotic addiction.
7. Status post abdominal retroperitoneal approach to lumbosacral spine.
8. Radical diskectomy, L4-5 and L5-S1.
9. Status post spondylolisthesis reduction and anterior spinal fusion.
10. Severe concave scoliosis, necessitating osteotomy.
11. Flat back deformity with decreased lumbar lordosis and forward
decompensation.

5. Surgical Strategy
1. Segmental spinal instrumentation, lumbar 1 to the sacrum and pelvis, with
CD Legacy 5.5 stainless steel screw-rod construct.
2. Sacral pelvic fixation with bilateral iliac crest exposures.
3. Posterior spinal fusion, lumbar 1 to S1. This is a seven-level fusion,
including the pelvis.
4. Laminectomy, L3-L4, with bilateral lateral recess decompression for severe
spinal stenosis.
5. Concave osteotomy, lumbar 1-lumbar 2, lumbar 2-lumbar 3, lumbar 3-
lumbar 4, lumbar 4-lumbar 5 and L5-S1, for mobilization of flat back
deformity.
6. Repair of incidental durotomy.
7. Intraoperative fluoroscopy.
8. Intraoperative somatosensory evoked potentials.

6. Post-Op Films
The patient is doing quite well.
She has some minimal low back
pain, which was relieved with core
strengthening exercises, weight
reduction, and posture correction.
Her X-rays show excellent
alignment.
0°

7. Pre-Op/Post-op Comparison
28° 0°