Case Review #41: 35 year old female with a 92 degree Scoliosis

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A 35 year old female presented with Adult Idiopathic Scoliosis. Her thoracic curvature measured 92 degrees. The patient was experiencing upper and lower back pain. Dr. Pashman performed a posterior spinal fusion on the patient.

Case Review:
54° 35 year old female with
Progressive Adult
92°
Idiopathic Scoliosis.
Thoracic curve
measuring 92°
38°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

Patient History
• 35-year-old female
• Progressive Kim/SRP type
I Adult Idiopathic
54° Scoliosis
• Major thoracic curve
measuring in excess of 92
92°
degrees
58°
• Significant rotation and
38° deformity.
• Upper and lower back
pain.

Bending X-rays
Bending films show
neutralization and
middle stable
Harrington, plumb
line S1-L4.

Indications for Surgery
1. Progressive adult idiopathic scoliosis, Kim / Sagittal
Reconstruction Parameters type I, 5490 for 38° progressive
curvature with rotation deformity.
2. Significant upper back and low back pain due to progressive
deformity.
3. Failed conservative therapy.

Surgical Strategy
• Segmental spinal instrumentation thoracic 3 to lumbar 3 using
1/4- inch stainless steel pedicle screw rod construct.
• Posterior spinal fusion using locally harvested autogenous bone
Rh bone morphogenic protein and extender T3 to L3.
• Multiple level spinal osteotomy through ankylosed concave,
convex spine for inducement of flexibility thoracic 5-6, thoracic
6-7, thoracic 8-9, thoracic 9-10 and thoracic 11-12.
• Interlaminar laminectomy, mesial facetectomy and lateral recess
release for lateral recess stenosis and pedicle visualization lumbar
1-2 and lumbar 2-3 bilaterally.

Surgical Strategy – cont.
• Motor evoked potentials.
• Intraoperative fluoroscopic control.
• O arm CT intraoperative interpretation and neuronavigation
guidance thoracic spine.

Post-op Films
• The patient is well balanced
in both the sagittal and
coronal planes.
• The patient’s main curve was
reduced from 92° to 55°.
55° • She gained almost 2 inches in
height, and has minimal pain.

Pre-Op/Post-op Comparison

54°

55°
92°

38°

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