A 55 year old male presented with Progressive Adult Idiopathic Scoliosis. While he was preparing for surgery, he lifted a heavy item, and had neck pain and pain going down his arm. The patient was found to have myeloradiculopathy and spinal cord effacement and required an Anterior Cervical Fusion prior to scoliosis surgery. The following year he had a posterior spinal fusion for Scoliosis.

1. Case Review:
55 year old male with Progressive
Idiopathic Scoliosis. Found to
have cervical degeneration that
was addressed prior to his
Scoliosis Surgery.
55°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 55-year-old male
• KIM/SRP type II Adult Idiopathic Scoliosis
• Status-post cancer
• Low back pain
• Truncal shortening
• Patient followed for progression of Scoliosis and prepared for
surgery when he reported neck and arm pain after lifting a heavy
item.
• A MRI of the cervical spine shows multilevel degenerative
changes of the mid cervical spine with a surgical kyphosis. He
has significant levels of stenosis behind bodies of 4 and 5.

3. Patient History - cont
• Severe myeloradiculopathy with impending neurological
embarrassment due to significant cervical stenosis and kyphosis
due to collapse and degeneration with possible congenital
component from C3 to C7. This severe deformity is causing
effacement of the spinal cord and gliosis, and the patient now is
having increasing neck pain and disability with numbness and
weakness in his hands consistent with myeloradiculopathy.

4. Pre-op X-rays

5. Flexion and Extension X-rays

6. Indications for Surgery
1. Myeloradiculopathy due to severe spinal cord compression,
cervical spine.
2. Massive cervical compression due to combination of hard and
soft disks, C3-4, C405, C5-6 and C6-7.
3. Bilateral neural foraminal stenosis due to collapsing
degeneration, C3-4, C4-5, C5-6 and C6-7.
4. Severe cervical kyphosis due to collapse, degeneration. possible
congenital component with malformed vertebrae, C3, but global
sagittal imbalance.
5. Severe neck and arm pain, failed conservative therapy.
6. Multiple co-morbidities, including scoliosis and past treatment
for lymphosarcoma.

7. Surgical Strategy
• Radical diskectomy, C3-4, with epidural decompression under
the microscope for spinal cord compression, removal of hard
and soft disks.
• Radical diskectomy for removal of hard and soft disk and spinal
cord compression under microscope, C6-7.
• Complete vertebrectomy, C5, for removal of apical compression,
myeloradiculopathy and spinal cord compression.
• Radical diskectomy, C4-5 and C5-6, with epidural decompression
under the microscope and bilateral neural foraminotomy.
• Interbody fusion with PEEK device at C3-4 and C6-7 with
autogenous bone centrally.
• Strut graft reconstruction with Medtronic stackable PEEK
device with autogenous bone centrally, C4 to C6.

8. Surgical Strategy - cont
• Anterior plate fixation for reconstruction of cervical
kyphosis, C3 to C7 using a 10-hole Medtronic Vantage
plate screw system.
• Somatosensory-evoked potential management with
motor-evoked potentials.
• Intraoperative fluoroscopy management.

9. Post-op Films

10. Pre-Op/Post-op Comparison

11. Pre-op X-rays
The patient returned
approximately one year after
his cervical spine surgery to
address the progression of the
scoliosis.
There is significant rotation,
spinal stenosis at L2-3 which
55° is also the apex of the sagittal
and coronal plane deformity.

12. Indications for Surgery
1. KIM/short-rib polydactyly-type II adult idiopathic scoliosis,
greater than 60°, lumbar spine.
2. Lateral listhesis translation with maximum rotation at L2-3
causing instability and significant stenosis, lumbar spine.
3. Severe degeneration, lateral recess stenosis with increasing low
back pain, lumbar spine.
4. Thoracolumbar kyphosis due to collapsing scoliosis,
thoracolumbar spine.
5. Failed conservative therapy.
6. Status post multiple level anterior cervical vertebrectomy for
severe myeloradiculopathy.
7. Status post treatment for lymphosarcoma, in remission.

13. Surgical Strategy
• Segmental spinal instrumentation at T10 to sacral pelvis using 5.5 cobalt
chromium pedicle screw/rod construct.
• Complete vertebrectomy/kyphectomy L3 with pedicle subtraction
osteotomy for sagittal plane deformity.
• Complete laminectomy at L2, 3 and subtotal laminectomy at L4 for severe
spinal stenosis, decompression; all under the microscope.
• Posterior spinal fusion T10 to sacral pelvis with locally harvested
autogenous bone.
• Intraoperative repair of incidental durotomy under the microscope, 1 x 1
mm hole at L3 on the left.
• Separate incision in sacral pelvic fixation screw for sacral pelvic fixation.
• Use of O-arm navigation and intraoperative neuronavigation
interpretation.
• Intraoperative motor evoked potential interpretation.
• Multiple level Smith-Peterson osteotomy, T12, L1, L2, L3 and L4 for
reduction of lumbar kyphosis.

14. Post-Op Films
The patient is well balanced in
both the sagittal and coronal
25° planes. He traveled to Europe
two months post-operatively, and
reported no increase in his
symptoms. He is thrilled with his
outcome.

15. Pre-Op/Post-op Comparison
55° 25°