A 50 year old female presented with a progressive 58° thoracic curve, and 60° lumbar curve. No previous surgeries. KIM/SRP Classification 3

1. Case Review:
Adult Idiopathic Scoliosis with
progressive 58° thoracic curve
and 60° lumbar curve
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
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2. Patient History
50-year-old female, diagnosed with Adult Idiopathic Scoliosis, no
previous surgeries.
No non idiopathic history such as neuromuscular problems or
structural abnormalities including congenital abnormalities of her
spine.
The patient is otherwise in good health, having quit smoking
approximately 8 years ago.
The scoliosis and progressive deformity are associated with
significant pain that related to her right flank where the curve is of its
largest magnitude, and the patient is also having neck, thoracic and
low back pain, and radiculopathy, which is currently being managed
by escalating amounts of narcotics.
Her shoulders are level. She has a right rib hump, left flank fullness
associated with a significant flank crease on concave right side.
Pelvis seems to be level. Leg lengths are equal and neurologically
she is intact. She is well-balanced in the frontal and sagittal planes
and looks otherwise healthy
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3. Pre-op X-rays
The patient has a 58° upper
thoracic, 60° lumbar curve with
significant rotation. She has
significant fractional
58° lumbosacral obliquity but
otherwise is well-balanced in
the frontal and sagittal plane.
The patient's symptoms will
definitely be progressive over
60° the long term. We know that
statistically because adults with
curves greater than 50°
progress at approximately 1°
per year.
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4. Indications for Surgery
Adult progressive idiopathic scoliosis, 60° lumbar progression with
compensatory thoracic curve.
Lumbosacral anomaly with significant lumbosacral obliquity.
Stenosis of foramen with low back pain.
Failed conservative therapy.
Low back pain and radicular symptoms.
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5. Surgical Strategy
Posterior spinal instrumented fusion using Alphatec pedicle screw
rod construct from T3 to sacral pelvis, 5.5 stainless steel.
Spinal osteotomy Smith-Petersen and a Ponte osteotomy, T5-6, T6-
7, T7-8, T8-9, T9-10, T10-11, T12-L1, L1-2, L3-4, L4-5, L5-S1, 11-
level, for mobilization of rigid spinal deformity.
Interlaminar decompression for concave stenosis L2-3, L3-4, L4-5,
L5-S1 under loupe and headlight magnification.
Interlaminar laminotomies with facetectomy lateral recess release on
the left-hand side at L3-4, L4-5, L5-S1.
Posterior spinal fusion with locally harvested autogenous bone and
rhBMP T3 to sacral pelvis.
Motor evoked potentials.
Intraoperative fluoroscopy.
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6. Post-Op Films
The patient is balanced
in both the frontal and
28° sagittal planes.
30°
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7. Pre-Op/Post-op Comparison
The patient’s curvature
was reduced by 50%,
from 60° to 30°. She
28° gained several inches in
58°
height, and was very
happy with the outcome
60° of her surgery.
30°
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8. Pre-Op/Post-op Comparison
The patient is balanced
in the sagittal plane, and
no longer has symptoms
in her legs.
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