1. This case review summarizes the treatment of a 43-year-old female patient with adult scoliosis and a lumbar sacral transitional vertebra. 2. She had a 40 degree lumbar curve and a fused L5-S1 region on the right side. 3. Her treatment plan involved an anterior interbody fusion at L4-5 and L5-S1 followed by posterior segmental spinal instrumentation, spinal osteotomies, and posterior spinal fusion to correct her deformities and relieve her pain.

1. Case Review:
43 year old female with Adult
Scoliosis and lumbar sacral
transitional vertebra.
40°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
43-year-old female.
Diagnosed with Scoliosis at age 3.
Right leg pain.
Failed conservative therapy.
The patient has a fairly large right thoracolumbar prominence on
forward bending and she has a truncal shift to the right. She is
otherwise balanced in the sagittal plane.

3. Pre-op X-rays
The patient has a lumbar
curve measuring
approximately 40°.
She also has a transitional
L5-S1 segment with a
fused L5-S1 region on
the right.
40°

4. Indications for Surgery
1. Kim/SRP type II adult idiopathic scoliosis.
2. Adult idiopathic possible congenital and degenerative scoliosis.
3. Severe low back pain due to multiple-level degenerative disk
disease.
4. Multiple-level foraminal lateral recess stenosis with combination
of low back and leg pain.
5. Failed conservative therapy.
6. Coronal and sagittal plane deformity.
7. Bilateral facet arthropathy due to degeneration.
8. Multiple comorbidities including narcotic tolerance.
9. Radiculopathy.
10. Lumbosacral transitional vertebrae.

5. Surgical Strategy
Anterior interbody fusion L4-5 Segmental spinal instrumentation using
and L5-S1 with radical quarter-inch stainless steel screw-rod
diskectomy and epidural construct, for Kim/SRP type II scoliosis,
decompression. thoracic 10 to sacral pelvis.
Abdominal retroperitoneal Spinal osteotomy, multiple level, for
approach to the lumbosacral correction of sagittal plane and coronal
spine. scoliosis deformity, L1-2, L2-3, L3-4, L4-
Interbody fusion with with 5.
autogenous bone centrally L4-5, Posterior spinal fusion using locally-
L5-S1. harvested autogenous bone and rhBMP,
Anterior screw fixation L4-5, L5- T10 to the sacral pelvis.
S1. Pelvic fixation with bilateral exposure
Reduction kyphosis and through iliac crest through separate
correction of coronal plane incision.
deformity lumbosacral joint. Intraoperative SSEP with motor-evoked
Intraoperative somatosensory potentials.
evoked potentials. Intraoperative O-arm localization and
Intraoperative fluoroscopy. fluoroscopy.

6. Post-Op Films
The patient is well balanced
in the sagittal plane.
She is very happy with her
outcome, and reports no
symptoms.

7. Pre-Op/Post-op Comparison