Case Review #5: 67 year old woman with flatback syndrome following 5 spinal surgeries
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A 67 year old female presented to Dr. Pashman with severe Flat back Syndrome after 5 previous spine surgeries for Adult Idiopathic Scoliosis. Dr. Pashman treated her with a Posterior Spinal Fusion from T8 to S1.
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Case Review #5: 67 year old woman with flatback syndrome following 5 spinal surgeries
- 1. Case Review: 67 year old Female presented with Flatback after five previous Scoliosis Surgeries Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
- 2. Patient History 67-year-old female Approximately 5 previous operations for Adult Idiopathic Scoliosis Pseudoarthrosis, multiple times at L5-S1 Ultimately the patient had been fused up to T8, which had resulted in iatrogenic flatback deformity with severe forward decompensation. The patient could not walk upright, but necessarily needed to flex hips and knees to maintain upright gait. The patient also has severe cervical stenosis found on MRI, although she does not have upper motor neuron symptoms. Clearly her sagittal imbalance is causing more neural compression as the patient attempts to hyper-lordose her neck to compensate for the severe decompensation. Forward decompensation is causing significant buttock and posterior thigh pain The patient's past medical history is significant for treatment for breast cancer including chemotherapy and radiation.
- 3. Pre-op X-rays The patient’s head is approximately 14 cm anterior to the sacrum.
- 4. Indications for Surgery Iatrogenic flat-back, status post multiple operations for adult idiopathic scoliosis. Severe low back and leg pain due to forward decompensation. Significant radiculopathy due to nerve stretch symptoms including neurapraxia. Multiple co-morbidities including factor V deficiency, hypertension, cervical stenosis. Failure to function because of forward decompensation, low back pain. Status post breast cancer treatment including chemotherapy and radiation.
- 5. Surgical Strategy Segmental spinal instrumentation, T8 to sacrum Posterior spinal fusion, T8 to S1 using locally-harvested autogenous bone and osteotomy bone. Complete laminectomy, L1, L2 and L3. Lateral recess decompression, L2-3, L3-4 and L1-2 for isolation of nerves. Complete vertebrectomy, kyphectomy, pedicle subtraction osteotomy to induce realignment of flat-back syndrome, lumbar 2. Spinal osteotomy, T8-T9, T9-T10, T11-T12 for removal of retained hardware and harvesting autogenous bone. Intraoperative CT management using O-arm and neuronavigation for placement of pedicle screws through fusion mass. Intraoperative motor-evoked potential management and SSEP management. Plastic closure, status post multiple operations, lumbar spine. Removal of retained hardware, T8 to S1 previously placed, producing iatrogenic flat-back.
- 6. Post-Op Films The patient is well balanced in both frontal and saggital planes.
- 8. Pre-Op/Post-op Comparison The patient is very happy with her outcome. Her symptoms resolved, and she returned to work at 3 months post-op, and