Case Review: Adult Idiopathic Scoliosis treated with a spinal fusion from T2 to Pelvis70° Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
Patient History60-year-old female.Adult Idiopathic Scoliosis, 50+ degree curvature.Status post anterior interbody fusion at L4-5 and L5-S1.The patient has significant thoracic kyphosis andthoracolumbar kyphosis. She reports increased painover this area.The patient has significant left lumbar fullness. She isdecompensated to the left.The patient is losing height.Intermittent radiculopathy
Pre-op X-rays She has a severe kyphoscoliosis with a 70° thoracolumbar curve. It is a fixed deformity including frontal and sagittal plane70° decompensation.
Indications for Surgery1. Adult idiopathic scoliosis, thoracolumbar curve greater than 70 degrees.2. Fixed lumbosacral kyphosis.3. Degeneration obliquity.4. Thoracic kyphosis due to kyphoscoliosis.5. Severe low back pain, leg pain due to the above diagnoses with lateral recess stenosis, L1-2 to L5-S1, due to curvature.6. Failed conservative therapy.7. Status post anterior abdominal retroperitoneal fusion, L4- 5, L5-S1
Surgical Strategy1. Segmental spinal instrumentation, T2 to sacral pelvis. This is a 16- level fusion using Cotrel-Dubousset Legacy 5.5 stainless steel screw rod construct with pelvic fixation.2. Sacropelvic fixation.3. Posterior spinal fusion, T2 to the pelvis, using locally harvested autogenous bone as well as RHBMP.4. Spinal osteotomy for mobilization of rigid kyphoscoliosis, including Smith-Peterson osteotomies, T4 to L3, with bilateral facet removal and interlaminar decompression. This is an 11- level osteotomy.5. Interlaminar decompression, T1 to L5-S1 bilaterally.6. Interlaminar decompression for stenosis using Loup magnification.7. Intraoperative motor evoked potentials and somatosensory evoked potentials.8. Intraoperative fluoroscopy.
Post-Op Films At 7 months post-op the patient is doing very well. No specific pain but she has some fatigue which is normal.38°
Pre-Op/Post-op Comparison The patient’s curvature was reduced by 84%70° 38°