Adult Scoliosis: Less Invasive Long Fusion to the Sacrum

Description

This 47-year-old female patient came to Dr. Bridwell with fairly big thoracic (the area near the rib cage and shoulder blades) and lumbar (waistline level between the rib cage and pelvis) curves. Her thoracic curve was at 81º, and her lumbar curve was at 71º.

She travelled to see Dr. Bridwell from Arizona, where she’d been told that she needed an anterior operation (when the surgeon approaches the spine from the front of the body) of both the thoracic and lumbar curves. She was also told that she’d need a posterior spinal fusion with instrumentation from the thoracic spine to the sacrum and pelvis.

Treatment

Dr. Bridwell and his team didn’t feel that such an invasive approach was necessary. Instead, he first performed a posterior spinal fusion with instrumentation to the sacrum and pelvis. He used some iliac bone graft—bone taken from the patient’s hip—and biologic proteins to help the vertebrae fuse.

Then, he performed a low anterior paramedian approach—he approached the spine from the front and in the middle of the patient’s body. He used bone graft and anterior column support in the lower three discs of the lumbar spine. This was a much smaller, less invasive anterior operation than the flank and thoracoabdominal approaches that were performed traditionally just a few years ago.

Result

Following surgery, the patient’s thoracic curve was 37º, and the lumbar curve was 25º.

At the last follow-up appointment (5 ½ years after surgery), the patient still showed a very solid fusion, which you can see on the x-rays. Additionally, you can see the improvement in the patient's body shape in the pictures.

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.