Adult Scoliosis: Lumbar scoliosis treated with a very short fusion

Description

A 49-year-old female patient came to Dr. Bridwell. Her lumbar curve had progressed from 27° to 46° over the years. She’s very healthy otherwise, and physiologically, she seems younger than her stated age.

Dr. Bridwell did an MRI, and it showed some component of disc degeneration of all segments in the lumbar spine, but the majority of the disc degeneration is at T12-L1, L1-L2 and L2-L3. (The ‘T’ stands for thoracic spine, which is your mid-back. The ‘L’ means lumbar spine, which is near your waistline level between the rib cage and pelvis. The numbers designate the vertebral level, so L1 is your first lumbar vertebra.)

As we age, disc degeneration is a common occurrence; degeneration is simply the effect of the wear and tear of aging. However, it doesn’t always cause back pain, but this patient did have back pain.

The patient’s area of discomfort is mainly the mid-lumbar spine (waistline level between the rib cage and pelvis) rather than at the end of the lumbar spine. She doesn’t have radiating pain—that is, it’s just her back that hurts, and she doesn’t have pain that shoots down her legs (that’s known as radicular pain).

Treatment

Rather than performing a posterior spinal fusion with instrumentation to the sacrum and pelvis, as is frequently warranted in patients in this age group, Dr. Bridwell and his team performed an anterior spinal fusion—that means he approached the spine from the front of the body. He used a straightforward thoracoabdominal approach, and he did a very short fusion using a 2-screw/2-rod construct.

The screws and rods held and stabilized the spine while the bones healed and fused in their new position.

Result

After surgery, the patient’s lumbar curve was 28°. Now, it’s been many years since her surgery, and she still fells that her deformity is better, and she has less pain. She still has a very mobile spine.