A 59 year old female presented to Dr. Pashman with a 60 degree throacic curve, in extreme pain. She failed conservative therapy and opted to have scoliosis surgery.

1. Case Review:
59 year old female with
60° collapsing and painful
Adult Idiopathic Scoliosis
60°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 59-year-old female with a
• 60-degree thoracic, 60-degree lumbar KIM/SRP type 3 curve
with significant 30- degree thoracolumbar kyphosis making this a
KIM 3 classification.
• The patient has failed conservative therapy.
• The curve is collapsing and progressive and is painful.

3. Pre-op X-rays
KIM/SRP type 3 curve
that is measuring 60
degree thoracic, 60
degree lumbar with
60° significant rotation
lumbar, and at least a
30-degree
thoracolumbar
60° kyphosis.

4. Indications for Surgery
1. KIM/SRP type 3 adult idiopathic scoliosis with greater than 50
degrees thoracolumbar curvature.
2. Thoracolumbar kyphosis with significant degeneration greater
than 20 cm, greater than 30 degrees thoracolumbar kyphosis.
3. Severe low back pain and radicular symptoms due to 60 degrees
thoracic, 60 degrees lumbar KIM/SRP type 3 adult idiopathic
scoliosis and rotation.
4. Failed conservative therapy.

5. Surgical Strategy – part 1
• Abdominal retroperitoneal approach to lumbosacral spine.
• Radical diskectomy L5-S1.
• Interbody fusion with polyetheretherketone device, 10-mm
medium with rhBMP centrally.
• Anterior screw fixation L5-S1.
• Intraoperative somatosensory evoked potentials.
• Intraoperative fluoroscopy.

6. Surgical Strategy – part 2
• Thoracic 3 to sacral pelvic segmental spinal instrumentation
using 1/4-inch stainless steel screw-rod complex.
• Posterior spinal fusion T3 to sacral pelvis using locally harvested
autogenous bone mixed with cancellus allograft in the bone mill.
• Multiple level Smith-Petersen osteotomy at T10-11, T11-12,
T12-1, T12-L1, L1-L2, L2-L3, L3-L4, L4-L5, as well as T5-T6,
T6-T7, T8-T9 and T10-T11.
• Intraoperative O-arm neuro navigation.
• Intraoperative SSEP motor evoked potential evaluation.

7. Post-op Films
10°

8. Pre-Op/Post-op Comparison
60°
10°
60°