A 60 year old male presented with a 50+ degree curvature. He was status post lumbar fusion from L4-S1, and continued to have significant low back pain.

1. Case Review:
Adult Idiopathic Scoliosis treated
with a spinal fusion from
T2 to Pelvis
70°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
60-year-old female.
Adult Idiopathic Scoliosis, 50+ degree curvature.
Status post anterior interbody fusion at L4-5 and L5-S1.
The patient has significant thoracic kyphosis and
thoracolumbar kyphosis. She reports increased pain
over this area.
The patient has significant left lumbar fullness. She is
decompensated to the left.
The patient is losing height.
Intermittent radiculopathy

3. Pre-op X-rays
She has a severe kyphoscoliosis
with a 70° thoracolumbar curve.
It is a fixed deformity including
frontal and sagittal plane
70° decompensation.

4. Indications for Surgery
1. Adult idiopathic scoliosis, thoracolumbar curve greater
than 70 degrees.
2. Fixed lumbosacral kyphosis.
3. Degeneration obliquity.
4. Thoracic kyphosis due to kyphoscoliosis.
5. Severe low back pain, leg pain due to the above
diagnoses with lateral recess stenosis, L1-2 to L5-S1,
due to curvature.
6. Failed conservative therapy.
7. Status post anterior abdominal retroperitoneal fusion, L4-
5, L5-S1

5. Surgical Strategy
1. Segmental spinal instrumentation, T2 to sacral pelvis. This is
a 16- level fusion using Cotrel-Dubousset Legacy 5.5
stainless steel screw rod construct with pelvic fixation.
2. Sacropelvic fixation.
3. Posterior spinal fusion, T2 to the pelvis, using locally
harvested autogenous bone as well as RHBMP.
4. Spinal osteotomy for mobilization of rigid kyphoscoliosis,
including Smith-Peterson osteotomies, T4 to L3, with bilateral
facet removal and interlaminar decompression. This is an 11-
level osteotomy.
5. Interlaminar decompression, T1 to L5-S1 bilaterally.
6. Interlaminar decompression for stenosis using Loup
magnification.
7. Intraoperative motor evoked potentials and somatosensory
evoked potentials.
8. Intraoperative fluoroscopy.

6. Post-Op Films
At 7 months post-op the
patient is doing very
well. No specific pain
but she has some
fatigue which is normal.
38°

7. Pre-Op/Post-op
Comparison
The patient’s curvature
was reduced by 84%
70° 38°

8. Pre-Op and
Post-op
Comparison