A 54 year old female with progressive Idiopathic Scoliosis presented with low back pain and leg pain. Due to her daily function declining, the patient chose to have spinal surgery.

1. Case Review:
54 year old female, with
Progressive Adult Idiopathic
Scoliosis and leg pain
59°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 54-year-old female
• Greater than 50 degree Kim/SRP type 2 Adult Idiopathic
Progressive Scoliosis with decompensation
• Low back pain, leg pain
• The patient says her functional tolerance is degrading with time
which is classic of highly angular and degenerative scoliosis
specifically with a fractional kyphotic component

3. Pre-op X-rays
She is decompensated in the
coronal plane to the right
approximately 2 cm, and has a
fractional lumbar kyphosis. She
has asymmetric folds on the left-
hand side as opposed to the right.
This is due to truncal shift and
59° scoliosis of the low lumbar spine.
Otherwise she is neurologically
intact.

4. 1. Kim/SRP type 2 adult idiopathic scoliosis, progressive, greater than 50 degree curve 2. Fractional lumbar kyphosis. 3. Preoperative for posterior instrumented fu
Indications for Surgery
1. Kim/SRP type II Adult Idiopathic Scoliosis, progressive,
greater than 50 degree curve
2. Fractional lumbar kyphosis.
3. Low back and leg pain.
4. Coronal and sagittal decompensation with thoracolumbar
kyphosis, decompensation of the fractional lumbar curve to the
right, significant rotation of the spine, and status post anterior-
posterior spinal fusion L4-5, L5-S1.

5. Surgical Strategy – Stage One
• Abdominal retroperitoneal approach to the lumbosacral spine.
• Radical diskectomy, L4-5, L5-S1.
• Interbody fusion with ALIF device, alpha Tek 10-mm medium
L4-5, L5- S1.
• Anterior screw fixation L4-5, L5-S1 fully threaded screw over
rod.

6. Surgical Strategy – Stage Two
• T10 to sacral pelvic posterior instrumented fusion using ¼ inch
stainless steel pedicle screw/rod construct.
• Posterior spinal fusion T10 to the sacral pelvis with locally
harvested autogenous bone and allograft.
• Smith-Petersen osteotomy to induce flexibility and coronal and
sagittal plane correction L1-2, L2-3, L4-5 and T10-11.
• Intraoperative neuronavigation with O arm.
• Intraoperative somatosensory evoked potential and motor
evoked potential monitoring.

7. Pre-Op/Post-op Comparison
59° 23°