A 53 year old woman, with an 85° thoracic curve, and a 75° lumbar curve. Dr. Pashman treated her with an Anterior fusion followed by a Posterior Spinal Fusion from T1 to the Pelvis. Curve was a KIM/SRP Classification 3.

1. Case Review:
Adult idiopathic Scoliosis
85˚
75˚ double major curve with
significant rotation
75˚
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
53 year old female
Presented with 85˚ thoracic and 75˚ lumbar curvature
Right thoracic/left lumbar curve with flank rotation, a
small rib hump. She is well balanced on frontal and
sagittal plane, has significant asymmetric skin folds but
her shoulders and pelvis appear balanced. She is in
good health and is very lean.
Right leg pain
Spinal Stenosis and Facet dislocation at L4/5
Failed conservative therapy

3. Pre-op X-rays
The patient has a well
documented history of
85˚ scoliosis progression,
and has obtained
several opinions about
the treatment options.
75˚

4. Bending X-rays
L R

5. Bending Films
L R

6. Indications for Surgery
Severe low back pain and radicular pain
75˚ adult idiopathic scoliosis, double major curve, with
significant rotation.
Degenerative disc disease, L4-5 and L5-S1.
Lateral recess stenosis, and instability lumbar spine.
Failed conservative therapy.

7. Surgical Strategy
STAGE 1
Radical diskectomy with epidural decompression, L4-5 and L5-S1.
Subtotal vertebrectomy for placement of screw fixation, L5.
Anterior interbody fusion with FRA device and putty graft, L5-S1 and L4-5, Anterior screw
fixation, L4-5 and L5-S.
STAGE 2
Segmental spinal instrumentation using 5.5 stainless steel Legacy thoracic tented pelvis.
This is an 8-level fusion.
Sacral pelvic fixation with bilateral exposure of the iliac crest.
Posterior spinal fusion T10 to the pelvis using locally harvested autogenous bone.
7-level osteotomy through ankylosed spine, Smith-Peterson osteotomy T11 to the
sacrum.
Subtotal laminectomy T12 to L5.
STAGE 3
T2 to L2 12-level segmented spinal instrumentation
Posterior spinal fusion, T2 to L2, using locally harvested autogenous bone and rhBMP.
Spinal osteotomy, T4-T5, T5-T6, T6-T7, T7-T8, T9-T10, and T11-T12 for rigid adult
idiopathic scoliosis. These are Smith-Peterson osteotomies through ankylosed and rigid
spine.

8. Findings during surgery
At the time of operation, severe rigidity ankylosing
especially in the concave side of the spine. Each joint
was fused, this in the concavity from L1 to L5 with the
joints ankylosed, a few solid to the pars, through big
degenerative changes. This required multiple level
osteotomy as indicated in the procedure section. The
patient was mobilized after that. The surgery took
significantly longer than expected because of the need
for multiple level surgery and therefore the third stage
will be completed on an interval basis.

9. Post-Op Films
X-rays show excellent
balance in frontal and
sagittal plane, good
correction of the curve.
All the instrumentation
looks intact.

10. Pre-Op/Post-op Comparison
The patient has no
post-operative
radiculopathy, and
minimal pain. She is not
taking pain medication.
Overall, she is doing
quite well.

11. Pre-Op/Post-op Comparison