A 58 year old male presented with lumbar scoliosis and severe kyphosis. Treated with a Posterior Spinal Fusion T10-Pelvis. KIM/SRP Classification 2.

1. Case Review:
Spinal Reconstruction with a
Pedicle Subtraction Osteotomy
for Lumbar Scoliosis
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
58-year-old male
Patient presented with Scoliosis, with significant rotation and severe lumbar
kyphosis.
The initial deformity may have been set up by lumbosacral transitional
vertebrae with apical wedging at the lumbosacral junction causing oblique
take off and lumbar kyphosis with degeneration.
Critical spinal stenosis from L3 to L5, neurogenic claudication. This is
dynamic claudication and leg pain.

3. Pre-op X-rays
The patient has a significant lumbar
deformity, with lumbar rotation and
kyphosis. These have left him off
balance.
A minimally invasive procedure or a
laminectomy would destabilize his spine,
and if a minimally invasive procedure was
performed, he would require further
surgery down the road.

4. Indications for Surgery
Severe spinal deformity with lumbar kyphosis.
Spinal deformity with lumbar scoliosis.
Critical spinal stenosis, L3-4, L4-5 and L5-S1 with neurogenic claudication.
Lumbosacral anomaly with possible hemi-vertebrae formation.
Significant to low back and leg pain.
Failed conservative therapy.

5. Surgical Strategy
Segmental spinal instrumentation, T10 to sacral pelvis, that is an 8-level
fusion.
Segmental spinal instrumentation using CD Legacy 5.5 stainless steel
screw rod construct.
Posterior spinal fusion T10 to sacral pelvis using locally harvested
autogenous bone.
Spinal osteotomy T11-12, T12-L1 and L1-2 for reconstitution of
thoracolumbar lordosis.
Complete laminectomy of L3 to L5 for spinal stenosis and mobilization for
PSO.
Spinal kyphectomy L3 for realignment of lumbar kyphosis.
Intraoperative SSEP.
Intraoperative fluoroscopic interpretation.
Interlaminar decompression L5-S1 bilaterally.

6. Post-Op Films
The patient is doing well post-operatively.
He will visit the clinic where x-rays will be
taken on a scheduled basis. At one year
post-op the fusion should be complete.

7. Pre-Op/Post-op Comparison
The spinal curvature was corrected and
stabilized in both the frontal and sagittal
planes with this procedure.

8. Pre-Op/Post-op Comparison
The patient’s spinal balance has
been restored. As you can see on
the left (pre-op) X-ray, his head was
not balanced over his hips; he was
decompensated in a forward
position. This was corrected with
the surgery.
Pre-op Post-op