The document reviews a case of a 38-year-old female with adult idiopathic scoliosis who underwent a posterior spinal fusion from T3 to L4 after conservative treatments failed. The surgery involved significant instrumentation and osteotomies, resulting in a successful reduction of her curvature from 52° to 20°, with excellent post-operative balance and minimal pain. Pre- and post-operative x-rays indicate significant improvement in her spinal alignment and overall condition.

1. Case Review:
52°
Adult Idiopathic Scoliosis
treated with a posterior
fusion from T3 to L4 fusion
48°
Robert S Pashman, MD
Scoliosis and Spinal Deformity
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2. Patient History
38-year-old female presented with a double major cure measuring thoracic
40°, lumbar 44° curvature
The patient was diagnosed with Adolescent Idiopathic Scoliosis at age 9,
and wore a Milwaukee brace until age 16. During this time, her curvature
progressed from 17° to 45 °
When she initially presented, she was well balanced in the frontal sagittal
plain, maybe a cm decompensated to the left but the shoulders and pelvis
were level. The patient was sent for intensive physical therapy and told to
return for repeat x-ray every three to four months to monitor for progression
of the curve.
Six years later – the patient presented with 50° right and 46° left curve.
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3. Pre-op X-rays
There was significant rotation in both
curves, and actually the thoracolumbar or
lower lumbar curve was more deforming
52° in that she had a significant elevation of
her left flank. This was due to fractional
kyphosis at the thoracolumbar junction.
There was no question that the spinal
fusion and reconstruction need to
48° traverse both curves.
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4. Bending X-rays
L R
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5. Indications for Surgery
Adult idiopathic scoliosis double major curve, measuring 52 and 48,
respectively, thoracolumbar spine.
Rigid kyphosis, thoracolumbar junction
Severe superimposed degenerative disk disease and facet arthropathy, with
mid lumbar degeneration causing rigid compensatory curve with
thoracolumbar kyphosis.
Low back/lower extremity symptoms, with spinal stenosis, neural foraminal
stenosis lumbar spine.
Failed conservative therapy.
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6. Surgical Strategy
Segmental spinal instrumentation, thoracic 3 to lumbar 4; this is a 13-level
instrumentation, with 5.5 stainless steel Legacy screw-rod construct.
Posterior spinal fusion, thoracic 3 to lumbar 4, with autogenous bone and
Rh bone morphogenic protein.
Because of the rigidity of this curve, it required significant mobilization,
which necessitated multiple-level osteotomies for correction of the curve in
a posterior only basis. Ponte osteotomy, radical mobilization of the spine,
with complete facetectomy resection, thoracic 5 to lumbar 3-4. This is a 10-
level osteotomy, with correction of coronal and sagittal plane deformity.
Subtotal laminectomy, thoracic 12 to lumbar 1, lumbar 1-2, lumbar 2- 3, and
lumbar 3-4 under loupe magnification for spinal canal decompression and
spinal stenosis.
Intraoperative motor evoked potential interpretation.
Intraoperative fluoroscopic interpretation.
Plastic closure.
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7. Post-Op Films
The patient is doing quite well. Her
balance is excellent, the incision is
well healed. She has minimal pain,
and has no radiculopathy.
X-rays show excellent balance in the
frontal and sagittal plane. This is a
very good result early on.
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8. Pre-Op/Post-op Comparison
An excellent correction was achieved.
52° 20° The patient’s curve was reduced
approximately 60%, from 52° to 20°.
48°
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9. Pre-Op/Post-op Comparison
The patient is well balanced in the frontal
and sagittal plane.
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