57 year old female with Adult Idiopathic Scoliosis. She presented with a 62 degree thoracolumbar curve. Dr. Pashman treated the patient with a posterior spinal fusion from T10-Pelvis. Dr. Pashman took great care with incision closure to preserve the patient's tattoo. KIM/SRP Classification 2.

1. Case Review:
57 year old female with Adult
Idiopathic Scoliosis
62°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
57 year old female
Adult Idiopathic Scoliosis
Kim/SRP Type 3
Patient is a weightlifter, in is in good physical shape.
Patient reports losing height and progressive deformity.

3. Pre-op X-rays
The patient has a 62°
thoracolumbar curve,
with severe degeneration
of L4-5 and L5-S1 at the
fractional concavity.
The patient is well-
62° balanced in the sagittal
plane. The thoracolumbar
curve extends past the
thoracolumbar junction
and down to the sacrum.

4. Indications for Surgery
1. Kim/SRP type 3 adult idiopathic scoliosis.
2. Severe degenerative lumbosacral oblique take-off.
3. Coronal and sagittal plane decompensation.
4. Unremitting low back and lower extremity radiculopathy due to
the above diagnosis.
5. Failed conservative therapy.
6. Asthma.
7. Osteopenia.

5. Surgical Strategy
Abdominal retroperitoneal Segmental spinal instrumentation, T10 to
approach to the lumbosacral spine. sacral pelvis, using titanium pedicle screw,
Radical diskectomy L4-5, L5-S1 Cobalt Chrome 5.5 rod instrumentation.
with epidural decompression. Posterior spinal fusion, T10 to the sacral
Interbody fusion with PEEK pelvis using locally harvested autogenous
device, 8 mm at L4-5, and an FRA bone and allograft.
PEEK measuring 11 mm at L5-S1,
both with combination of allograft Smith-Peterson osteotomy for loosening
and rhBMP centrally. of lumbar spine, T10-11, T11- 12, T12-L1,
Anterior screw fixation, L4-5, L5- L1-2, L2-3 and L4-5.
S1. Lateral recess decompression L3-4 and
Intraoperative fluoroscopic L4-5.
control. Intraoperative O-ARM neuronavigation
with Stealth system.
Intraoperative somatosensory evoked
potentials and motor evoked potentials.
Plastic closure of wound.

6. Post-Op Films

7. Pre-Op/Post-op Comparison

8. Pre-Op/Post-op Comparison
The patient is perfectly
balanced in the sagittal plan.