The patient presented after two scoliosis surgeries and in situ fusions. The patient's spinal curvature progressed to 80 degrees and she required revision surgery.

1. Case Review:
64 year old female with
Scoliosis, status post in-situ
80° fusion as an adolescent.
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
64-year-old female
As an adolescent had 2 operations which were in situ onlay
fusions in the mid thoracic spine and the lower lumbar spine.
Bilateral iliac crest harvesting was done.
The patient now has adding on of progression through the
thoracolumbar open segment between these 2 massive fusion
masses. This is a very difficult situation because the patient's in
situ fusion included a greater than 80-degree proximal curve and
lumbar curve. In the significantly hypermobile lumbar segment
now is collapsing and compressing through these 2, large fusion
fragments. The patient also has a lumbosacral joint which is
open and was not fused.
Patient is small, low weight, and has multiple co-morbidities

3. Pre-op X-rays
80°

4. Indications for Surgery
Kim/SRP type III Adult Idiopathic Scoliosis.
Status post posterior spinal fusion times 2 as adolescent, interval
thoracic and interval lumbar spine.
Now with nonunion and interval open mobility thoracolumbar
junction at L5-S1 and proximally causing massive low back pain
and progression, adding on of the thoracolumbar junction
compression, lateral listhesis, instability, and degeneration.
Massive low back pain and progression, adding on of the
thoracolumbar junction compression, lateral listhesis, instability,
and degeneration.
Failed conservative therapy.
Multiple co-morbidities, including hypertension, osteopenia and
arthritis.

5. Surgical Strategy
Segmental spinal instrumentation thoracic 3 to the sacral pelvis
using 5.5 cobalt chrome high-strength rod-screw construct.
A separate incision for sacral pelvic instrumentation of right iliac
crest to a previously operated site.
Multiple-level spinal osteotomies, Smith-Peterson osteotomy at
T10- 11, T11-12, T12-L1, L1-L2 for mobilization of
thoracolumbar junction and correction of interval open
ankylosed Kim/SRP type III curve.
Posterior spinal fusion at T3 to the sacral pelvis using locally-
harvested autogenous bone.
Intraoperative O arm usage with neurologic navigation.
Intraoperative somatosensory evoked potential, motor evoked
potential management.

6. Post-Op Films
During surgery, a large fusion
mass was found in the upper
thoracic spine. From
approximately T10-L3, there was
no fusion mass. There was
significant arthritis. The
thoracolumbar junction was not
mobile, was rotated, ankylosed,
and needed osteotomy for
mobility to induce correction in
both the frontal and sagittal
planes. The L5-S1 was not fused,
either. The bone was generally of
significant soft texture.

7. Pre-Op/Post-op Comparison
At her seven month post-
op appointment, the
patient says that she is
much better, has minimal
pain. She says that it has
made a significant
difference in her life.

8. Pre-Op/Post-op Comparison
The instrumentation is in excellent
position, and the patient is well
balanced.