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57 year old female with Adult Idiopathic Scoliosis. She presented with a 62 degree thoracolumbar curve. Dr. Pashman treated the patient with a posterior spinal fusion from T10-Pelvis. Dr. Pashman took great care with incision closure to preserve the patient's tattoo. KIM/SRP Classification 2.
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Case Review:
57 year old female with Adult Idiopathic Scoliosis
Robert S Pashman, MDScoliosis and Spinal Deformity Surgerywww.eSpine.com
62°
Patient History
57 year old female57 year old femaleAdult Idiopathic ScoliosisAdult Idiopathic ScoliosisKim/SRP Type 3Kim/SRP Type 3Patient is a weightlifter, in is in good physical shape.Patient is a weightlifter, in is in good physical shape.Patient reports losing height and progressive deformity.Patient reports losing height and progressive deformity.
Pre-op X-rays
62°
The patient has a 62° thoracolumbar curve, with severe degeneration of L4-5 and L5-S1 at the fractional concavity.
The patient is well-balanced in the sagittalplane. The thoracolumbarcurve extends past the thoracolumbar junction and down to the sacrum.
Indications for Surgery
1. Kim/SRP type 3 adult idiopathic scoliosis. 1. Kim/SRP type 3 adult idiopathic scoliosis. 2. Severe degenerative 2. Severe degenerative lumbosacrallumbosacral oblique takeoblique take--off. off. 3. Coronal and 3. Coronal and sagittalsagittal plane plane decompensationdecompensation. . 4. Unremitting low back and lower extremity 4. Unremitting low back and lower extremity radiculopathyradiculopathy due to due to
the above diagnosis. the above diagnosis. 5. Failed conservative therapy. 5. Failed conservative therapy. 6. Asthma. 6. Asthma. 7. 7. OsteopeniaOsteopenia. .
Surgical Strategy
Segmental spinal instrumentation, T10 to sacral pelvis, using titanium pedicle screw, Cobalt Chrome 5.5 rod instrumentation. Posterior spinal fusion, T10 to the sacral pelvis using locally harvested autogenousbone and allograft. Smith-Peterson osteotomy for loosening of lumbar spine, T10-11, T11- 12, T12-L1, L1-2, L2-3 and L4-5. Lateral recess decompression L3-4 and L4-5. Intraoperative O-ARM neuronavigationwith Stealth system. Intraoperative somatosensory evoked potentials and motor evoked potentials. Plastic closure of wound.
Abdominal retroperitoneal approach to the lumbosacral spine. Radical diskectomy L4-5, L5-S1 with epidural decompression. Interbody fusion with PEEK device, 8 mm at L4-5, and an FRA PEEK measuring 11 mm at L5-S1, both with combination of allograft and rhBMP centrally. Anterior screw fixation, L4-5, L5-S1. Intraoperative fluoroscopic control.
Post-Op Films
Pre-Op/Post-op Comparison
Pre-Op/Post-op Comparison
The patient is perfectly balanced in the sagittal plan.
