35 year old male status post T4-L1 fusion for Adult Idiopathic Scoliosis, presented with junctional kyphosis. The patient was treated with a posterior spinal fusion from T2-L4. KIM/SRP Classification 1.

1. Case Review:
35 year old male, status
30° post T4-L1 fusion for
Adult Idiopathic Scoliosis
presented with junctional
kyphosis.
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 35-year-old male
• Status post T4-L1 fusion for Adult Idiopathic Scoliosis.
• The patient's construct is a Harrington Luque Wisconsin wire
construct with onlay of bone graft.
• Over the years, the patient had, because of some element of
sagittal plane decompensation, significant junctional kyphosis,
L1-2, L2-3, and L4, with severe retrolisthesis L2-3, L3-4 due to
attempt to compensate for the thoracolumbar kyphosis. This led
to severe pain.

3. Pre-op X-rays
Preoperative scanning showed
severe degeneration
30° subadjacent to the previous
fusion and superadjacent to the
previous fusion. The patient
had element of coronal plane
decompensation, also. He failed
conservative therapy

4. Indications for Surgery
1. Adult idiopathic scoliosis, KIM/SRP type 1 curve.
2. Status post posterior instrument fusion for adolescent
idiopathic scoliosis.
3. Now with junctional kyphosis subadjacent to previous fusion
with severe degeneration L1-2, L2-3, and L3-4.
4. Sagittal coronal plane decompensation.
5. Possible pseudoarthrosis.
6. Superadjacent degeneration and junctional kyphosis T2, T3.
7. Failed conservative therapy.

5. Surgical Strategy
• Segmental spinal instrumentation thoracic 2 to lumbar 4 using
pedicle screw, cobalt chromium rod construct.
• Posterior spinal fusion, T2-L4 using locally harvested autogenous
bone RHBNP and allograft putty.
• Spinal osteotomy for correction of junctional kyphosis, T12-L1,
L1- L2, L2-L3, and L4. 4. Superadjacent osteotomy for
correction of junctional kyphosis T3- T4.
• Intraoperative neuronavigation using O-Arm Stealth construct.
• Intraoperative SSEP motor-evoked potentials.
• Removal of retained hardware, a Luque Harrington Wisconsin
wire construct.

6. Post-op Films
• The patient is well balanced in
both the sagittal and coronal
planes.
• The patient is very happy with
his outcome. He and his wife
27° recently had a son, and his goal
for surgery was to be an active
father.

7. Pre-Op/Post-op Comparison
30° 27°