A 60 year old woman presented after a failed minimally invasive XLIF surgery for Adult Idiopathic Scoliosis. The patient had multiple complications, and required extensive revision surgery.

1. Case Review:
60 year old Female
status post failed
Minimally Invasive Surgery for
Adult Idiopathic Scoliosis
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 60-year-old female
• Status post an attempt at scoliosis correction with multiple level
XLIF and a percutaneous transfascial para lumbar percutaneous
pin fixation that was ultimately removed.
• The patient did not do well. She has an iatrogenic flat back with
collapse kyphosis probable pseudarthrosis 2 to L3. She had
significant sagittal and coronal displacement and the patient is
completely disabled from her symptoms.

3. Pre-op X-rays
The patient will need pedicle
subtraction osteotomy to reduce
sagittal plane balance and she
knows that this a significant
morbid operation because of the
redo nature.

4. Indications for Surgery
1. Status post "minimally invasive scoliosis correction with XLIF
and percutaneous instrumentation lumbar spine."
2. Complete failure of minimally invasive scoliosis correction with
removal of implants and collapse.
3. Iatrogenic kyphosis lumbar spine.
4. Multiple level pseudoarthrosis lumbar spine status post
"minimally invasive scoliosis correction adult idiopathic
scoliosis."
5. Severe flat back with low back plane in forward
decompensation.
6. Failed conservative therapy.
7. Status post removal of a paraspinous boil.

5. Surgical Strategy
• Segment 1, segmental spinal instrumentation thoracic 10 to
pelvis using quarter-inch stainless steel rod screw construct.
• Pedicle subtraction osteotomy in lumbar 3 with complete
kyphectomy, vertebrectomy L3 under the microscope.
• Laminectomy L2-L4 with spinal canal decompression under the
microscope.
• Posterior spinal fusion T10 to sacral pelvis using locally
harvested autogenous bone and Rh BMP.
• Intraoperative operating room neuro navigation.
• Intraoperative SSEP motor-evoked potential.

6. Post-op Films
The patient did very well post-
operatively, and was very
grateful for her results.

7. Pre-Op/Post-op Comparison