A 58 year old female presented with severe, progressive, Lumbar Scoliosis. The patient failed conservative therapy and had unrelenting leg pain. She was treated with a posterior spinal fusion from T11-pelvis.

1. Case Review:
58 year old famle, with
Adult Idiopathic Scoliosis
and low back pain.
38°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 56-year-old female
• Adult Idiopathic Scoliosis
• Progression of curve
• Low back pain
• Multiple epidurals

3. Pre-op X-rays
Approximately a 38° left lumbar
curve which is highly rotated and
degenerated.
She has a compensatory curve of
the thoracic spine which does not
appear rotated, but uncommonly she
has right shoulder depression which
indicates that either the lumbar
38°
curve is not being compensated for
or she has slight structurality of the
upper thoracic curve which is small.

4. Indications for Surgery
1. KIM/SRP type 2, severe lumbar scoliosis, idiopathic-de novo,
lumbar spine progressive, 35 to 50 degrees.
2. Severe rotation with significant degeneration and instability at
L3- 4.
3. Lumbosacral transitional vertebra with fixed lumbosacral
obliquity.
4. Thoracolumbar kyphosis with severe collapse and degeneration
at L3- 4.
5. Intraforaminal disk herniation L5-S1 on the right.
6. Failed conservative therapy including back pain and
radiculopathy of greater than one year.

5. Surgical Strategy
• T11 to sacral pelvis fixation with 5.5 cobalt chromium-titanium
pedicle screw-rod construct.
• Multiple level spinal osteotomy for reduction of lumbar kyphosis,
rotation and scoliosis, T12-L1, L1-2, L2-3 and L4-5 with bilateral
radical facetectomy and subrecess Smith-Peet osteotomy.
• Posterior spinal fusion, T10 to sacral pelvis using locally harvested
autogenous bone, allograft chips and RH BMP.
• Intraoperative SSEP and motor evoked potential.
• O-arm intraoperative CT navigation and use of Stealth navigation.
• Plastic closure of wound.

6. Post-op Films
• The patient is well
balanced in both the
sagittal and coronal plane.
• She is doing great, and
enjoying relief from her
back pain.
• She is very happy with her
outcome.

7. Pre-Op/Post-op Comparison
38°