Kyphosis: Sagittal Imbalance with Scoliosis and Spondylolisthesis

Description

When this patient first came to Dr. Bridwell, she already had an extensive history with spine surgeries. In 1963, when she was 12, she was diagnosed with scoliosis. As a teenager she had a scoliosis fusion with instrumentation to the L4 segment. She subsequently had the spinal implants removed.

Then, in 1996, her distal lumbar spine (just above the pelvis) became very painful. At that point, she had another spine surgery—not done by Dr. Bridwell—where she had a fusion and decompression from L4 to the sacrum. This was to treat her spondylolisthesis: one of her lumbar vertebra had slipped forward over the vertebra beneath it.

The surgery actually caused “flatback syndrome” and a component of post-laminectomy kyphosis L4 to the sacrum. Over the next two years, she was in a substantial amount of pain and progressively had a harder time standing up straight.

Treatment

Dr. Bridwell performed two surgeries on this patient. The first one was a posterior spinal fusion with instrumentation. He corrected the patient’s deformity by performing a single pedicle subtraction osteotomy at L3. This osteotomy resects a portion of the lamina, pedicles and vertebral bodies to substantially restore lumbar lordosis. The areas of nonunion and pseudarthrosis at L4-L5 and L5-S1 were corrected and fused as well.

The patient’s spine was then re-instrumented to the sacrum and pelvis. The spine was fused posteriorly and anteriorly from L4 to the sacrum. The pedicle subtraction procedure was performed at L3.

Note the dramatic improvement in SRS and Oswestry scores. Also, we performed a gait study post-operatively and found she was able to walk much farther and much more quickly than she was able to preoperatively.

Result

Following surgery, the patient was most excited that she could stand up straight again. She is also pain free now.