1. A 43-year old female with adult idiopathic scoliosis underwent anterior spinal surgery with instrumentation from T12 to L3 to correct curves of 60° thoracic and 57° lumbar, reducing them to 41°. 2. A 48-year old female with Kim/SRP type III scoliosis underwent revision surgery with anterior lumbar interbody fusion from L4-S1 and posterior spinal fusion from T3 to S1 to correct increasing proximal thoracic curvature and subadjacent degeneration. 3. Post-operatively, the patient was well-balanced in sagittal and coronal planes with thoracic and lumbar curves reduced to 26° and 27° respectively.

1. Case Review:
43 year old female treated with
60° an anterior surgery for a
double major Scoliosis
curvature, and was re-operated
57°
on five years later.
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 43-year-old female
• Status post anterior cervical
diskectomy
• Adult Idiopathic Scoliosis
60° • Lumbar curve with significant
progression
57°

3. Bending X-rays
Right and left side bending shows significant flexibility of the thoracic
and lumbar curve. She has some rotation of L4 and some fractional
lumbosacral obliquity with right side bending but nevertheless my
decision was to do a minimal operation through the anterior
approach, save her posterior musculature and watch her.

4. Indications for Surgery
1. Progressive adult idiopathic scoliosis with a 50° thoracic and 61°
lumbar curve.
2. Low back and leg pain due to progressive scoliosis.
3. Status post anterior cervical diskectomy and fusion.
4. Failure of conservative therapy.

5. Surgical Strategy
• Left T11 thoracoabdominal approach to the lumbar spine.
• Complete diskectomy T11-T12, L1-L2, L2-L3.
• Segmental spinal instrumentation for scoliosis correction at T12
to L3 using screw staple transvertebral instrumentation.
• Anterior interbody fusion with device, L2-3, FRA with
autogenous bone and RHBMP rib.
• Anterior interbody fusion using combination of autogenous rib
and RHBMP T12-L1, L1-L2 and L2-L3.
• Intraoperative somatosensory evoked potential monitoring.
• Intraoperative fluoro.

6. Post-Op Films
41°
41°

7. Pre-Op/Post-op Comparison
60° 41°
58°
41° 57° 41°

8. Patient History
• 48-year-old female
• Kim SRP type III curve.
• Originally attempted to be fixated with anterior fixation with
transvertebral screws at thoracolumbar spine. This ultimately did
well for quite some time, but the patient now has what happens
to be subadjacent degeneration, increasing at a proximal curve,
on balance shortening, and has pain.

9. Indications for Surgery
1. Kim/SRP type III adult idiopathic scoliosis.
2. Status post anterior spinal fusion of thoracolumbar curve.
3. Now with subadjacent degeneration and adding on increasing
curvature.
4. Failure of distal fixation of anterior fixation and increasing
proximal thoracic curve.
5. Lumbosacral degeneration L4-5 and L5-S1.

10. Surgical Strategy
• Abdominal retroperitoneal approach to lumbosacral spine.
• Complete radical diskectomy L4-5, L5-S1.
• Interbody fusion using PEEK device.
• Femoral ring allograft (FRA) and Alphatec L4-5 and L5-S1 with
allograft putty centrally and autogenous bone, plus blood.
• Anterior screw fixation, L4-5 and L5-S1.
• Intraoperative use of fluoroscopy.
• T3 to sacropelvic fusion using segmental spinal instrumentation,
titanium cobalt chrome rod pedicle screw construct.

11. Surgical Strategy – cont.
• Sacropelvic fixation with separate iliac crest exposure right iliac
crest.
• Posterior spinal fusion T3 to the S1 using locally harvested
autogenous bone allograft putty.
• Smith Peterson osteotomy T5-6, T6-7, T7-8, T7-9, T8-9, T9-10,
T10- 11, T12-L1, L1-2, L2-3 for inducing flexibility for balance
correction KIM-SRP III type curve.
• Neuronavigation using O-arm Stealth computer navigation and
interpretation.
• Intraoperative somatosensory evoked potentials motor evoked
potentials.
• Plastic closure of wounds.

12. Post-op Films
• The patient is well balanced
in both the sagittal and
coronal planes.
• She is very happy with her
26° outcome, and lives a full
and active life.
27°