Primary degenerative adult scoliosis, specifically in the lumbar spine, is characterized by degeneration of the disc and/or the facet joint that leads to an asymmetric loading of the spinal segment and consequently of a whole spinal area.
This again leads to an asymmetric deformity that develops de novo scoliosis after skeletal maturity. This late onset is usually around the age of 30/40.
It involves both the coronal and sagittal plane.
The patient in the pictures presented complaining for severe back pain, spinal claudication and impairment in daily life activities.
At the time of presentation, standard radiographs showed a severe adult scoliosis with sagittal and coronal imbalance with a stiff lumbar curve, although the patient presented all the compensatory mechanism with the aim to maintain the horizontal gaze (pelvic retroversion, extension of the thoracic spine).
Surgery was suggested because of the deformity magnitude and the disabilities reported by the patient.
A posterior three-column osteotomy (PSO) that consists in a resection of part of a vertebra was performed, followed by a posterior thoraco-pelvic instrumentation with pedicle screws and curve correction during the same intervention. The osteotomy is started by removing the posterior arch including the facet joints until only the pedicle stump at the transition to the posterior wall of the vertebral body is left with also the transverse process removed.
The pedicle stump is then excavated continuously into the vertebral body.
The remaining posterior bridge between the two wholes of the pedicle stumps is then resected.
The created “empty” wedge is then closed under compression. Years after the operation, the patient was pain free without any complications. The follow-up radiographs demonstrate a good deformity correction and a balanced spine.
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