Kyphosis and Scoliosis: Fusion to Correct Substantial Deformity

Description

A 62-year-old woman came to see Dr. Bridwell. Her body was significantly pitched forward, and she was leaning to the left. She had kyphosis, when the thoracic spine (the area near the rib cage and shoulder blades) curves too much, creating a hunchbacked look. Her thoracic spine curve was at 85º.

The patient’s deformity—the hump in her back—was very noticeable, and she was experiencing a lot of back pain. She couldn’t sit, stand, or walk for very long because her spinal balance was so poor. Because of the kyphosis, her left ribcage was actually resting on her left pelvis, and her chest wall and sternum were substantially collapsed.

Fortunately, her deformity was reasonably flexible. A flexible curve is easier to correct than a stiff or rigid curve.

Treatment

To correct the patient’s deformity, Dr. Bridwell did a posterior spinal fusion with instrumentation. This was a very long fusion: he went all the way from the upper thoracic spine to the sacrum and pelvis. Such a long fusion was necessary to correct the deformity.

Dr. Bridwell used pedicle screws, and then he attached rods to the pedicle screws. The screws and rods held and stabilized the spine while the bones healed and fused. He also used local bone graft (taken from the patient’s spine) mixed with fresh-frozen bone and biologic proteins.

No iliac or hip bone was taken. No anterior operation was needed.

Result

Following surgery, the patient’s thoracic kyphosis was corrected from 85° to 45º, which is physiologically normal and her 47° lumbar scoliosis was corrected to 0°. Three years after surgery (her most recent follow-up appointment), she has a solid fusion. You can see in her outcome scores that she’s very gratified with the results of her surgery: her score for self-image improved quite a bit.

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.