Adult Scoliosis: Double Major Curve, an Excellent Outcome

Description

When this 68-year-old female patient first came to Dr. Bridwell from Tennessee, he identified that she had a progressive double major scoliosis curve. Right before surgery, she had a 54° curve in her thoracic spine (the area near the rib cage and shoulder blades) and a 50° curve in her lumbar spine (waistline level between the rib cage and pelvis). However, those curves had been getting worse for the previous 15 years. In fact, the curves were 20° less just 10 years ago.

Treatment

To correct the curves, Dr. Bridwell performed a long instrumented posterior spinal fusion. He fused the patient’s spine from the thoracic spine to the sacrum and pelvis. Dr. Bridwell and his team used pedicle screw implants at all vertebral levels. To help the bones fuse better, Dr. Bridwell used local bone graft (bone taken from the patient’s spine) and biologic proteins.

Until recently, most studies have suggested that obtaining a spinal fusion with a long fusion to the sacrum, particularly in an older adult, is very difficult. In general, there is a fairly high pseudarthrosis/non-union rate—meaning that it’s hard to get the spine to fuse correctly in such a long fusion, and in many cases, the vertebrae do not fuse successfully.

However, Dr. Bridwell and his team were able to get this patient’s spine to fuse correctly. They did this by:

• using pedicle screw implants at all vertebral levels and sacropelvic fixation (as shown in the after surgery x-rays where you can see bigger screws going into the pelvis area)
• using a combination of local bone graft, fresh-frozen allograft bone, and biologic proteins

With these techniques—which are more current and newer than what other spine surgeons may use in a case like this—Dr. Bridwell obtained a solid fusion without having to perform any kind of anterior surgery (when he approaches the spine from the front of the body).

Result

At the most recent follow-up appointment—4 years after surgery—the patient is doing well. In spite of her age, she seems to have a very solid fusion and is functioning well.

Note on the Pre-op to Post-op Comparison questionnaire scores that for the pain, function, and mental health questions, the maximum score is 25; for the self-image question, the maximum score is 30; and for the satisfaction question, the maximum score is 10. For the SRS Scores Converted to 100-point Scale, 100 means no pathology. For the Oswestry Scores, 100 means maximum pathology; 1 means no pathology.