A 58-year-old female with severe rigid thoracolumbar kyphosis due to Scheuermann's disease and degeneration underwent a posterior spinal fusion from T2 to the pelvis. She had a 70 degree curvature that was rigid. The surgery involved segmental spinal instrumentation, multiple osteotomies to correct the curvature, decompression of neural elements, and an 18-level posterior fusion. Post-operatively, the patient's curvature was fully corrected and she gained 2 inches in height.

1. Case Review:
Severe Scheurmann’s
Kyphosis treated with a
70°
Posterior Spinal Fusion
from T2-Pelvis
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
58-year-old female
Severe rigid thoracolumbar kyphosis probably due to
Scheuermann kyphosis with superimposed degeneration.
This has caused a rigid sagittal plane deformity. The
hyperlordosis in the dorsal spine has caused a significant
neural foraminal stenosis degeneration.
Failed conservative therapy

3. Pre-op X-rays
70°

4. Flex/Extension X-rays
The flexion and extension films show the rigidity of the spine.

5. Indications for Surgery
1. Scheuermann kyphosis thoracolumbar spine.
2. Severe superimposed degeneration of thoracolumbar spine
due to sagittal deformity.
3. Scoliosis.
4. Compensatory hyperlordosis of lumbar spine causing severe
neural foraminal stenosis of thoracolumbar spine.
5. Failed conservative therapy.
6. Multiple co-morbidities including age, cachexia.
7. Rigid thoracolumbar kyphosis.

6. Surgical Strategy
Segmental spinal instrumentation, thoracic 2 to sacral pelvis.
This is an 18-level posterior instrumented fusion using CD
1/4-inch stainless steel rod screw construct.
Bilateral pelvic exposures through separate incisions for
placement of pelvic instrumentation.
Interlaminar laminotomy, mesial facetectomy, lateral recess
release decompression, L1-2, 2-3, 3-4, 4-5, 5-1 for severe
lateral recess and foraminal stenosis.
Smith-Peterson osteotomy through laminectomies and
bilateral radial facetectomies, T9-10, T10-11, T11-12, T12-
L1, L1-2, L2-3, L3-4, and L4-5.
Posterior lateral fusion using locally harvested autogenous
bone, T10, T2 down to the sacral pelvis.
Intraoperative somatosensory evoked potential monitoring.
Intraoperative fluoroscopy management.

7. Post-Op Films
The patient plumb lines
perfectly in both the sagittal
and coronal planes.

8. Pre-Op/Post-op Comparison

9. Pre-Op/Post-op Comparison
0°
70° The patient had a complete
correction of her curvature,
and gained 2 inches in height.