A 39 year old female with Congenital Scoliosis presented to Dr. Pashman. The patient had a fusion at age six, and her spinal curve continued to progress. Dr. Pashman treated the patient with a posterior spinal fusion from T3-Pelvis. KIM/SRP Classification 3.

1. Case Review:
39 year old female, with
progressive curvature
status post posterior
31°
spinal fusion at age 6 for
congenital scoliosis.
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 39-year-old female
• Multiple hemivertebrae with a sharp angular curvature proximally
and kyphosis, treated by in situ posterior spinal fusion at age 6.
• The patient now has progressive adding on of the subadjacent
thoracolumbar spine with severe rotation of the lumbar spine and
multiple level anomalies including lumbosacral transitional vertebra.
• She has a high left rib hump
• The patient's curve is increasing. This has been documented serially
with 1996 to current films.
• The patient has significant upper and lower back pain, which has
been uncontrolled with conservative therapy.
• The progressive nature of the scoliosis and junctional aspects of the
previous surgery are the causative etiology.

3. Pre-op X-rays
She has a significant T1 tilt
with an oblique neck done
and decompensation to the
right. She has a
compensatory right
thoracolumbar elevated
flank. She also has evidence
31° of decreased lumbar
lordosis due to what
appears to be a lumbosacral
transitional vertebra.

4. Indications for Surgery
1. Progressive congenital scoliosis, thoracolumbar spine.
2. Status post posterior in situ fusion at age 6 for congenital
scoliosis.
3. Kyphoscoliosis with frontal and sagittal plane deformity and
decompensation.
4. Increasing back pain with junctional degeneration between
previous posterior spine and residual thoracolumbar spine.
5. Multiple vertebral anomalies including proximal thoracic
hemivertebrae with hemi-metameric shift, multiple level
lumbosacral anomalies with spina bifida occulta and lumbosacral
transitional vertebrae.
6. Failed conservative therapy with now progressive lumbar
rotation, pain, and decompensation.

5. Surgical Strategy
• T3 through sacropelvic fusion using cobalt-chrome 5.5 titanium
pedicle screw/rod construct.
• Posterior spinal fusion, T3 to pelvis, using locally harvested
autogenous and allograft bone.
• Multiple level spinal osteotomies, Smith-Petersen, with radial
facetectomy and removal of joint to produce harmonious sagittal
and coronal contouring, T4-5, T5-6, T6-7, T7-8, T9-10, T10-11,
L1-2 and L2-3.
• Repair of junctional pseudarthrosis, T6,T7, with locally harvested
autogenous bone.
• Intraoperative exposure of right hemipelvis with placement of
pelvic instrumentation.

6. Surgical Strategy – cont.
• Repair of bilateral pars interarticularis fractures, L5-S1, with
locally harvested autogenous bone and open reduction internal
fixation.
• Intraoperative O-arm neuronavigation interpretation.
• Intraoperative somatosensory-evoked and motor-evoked
potentials intraoperative interpretation.
• Plastic closure of T3 to sacropelvic wound.

7. Post-op Films
18°
The patient is well balanced in
the sagittal plane. She is
thrilled with her outcome and
new body image.

8. Pre-Op/Post-op Comparison
18°
31°