Primary degenerative adult scoliosis is a tridimensional deformity that affects the thoracic or thoracolumbar spine throughout the ageing process.
It has a substantially debilitating effect on patients’ general health. Spinal deformity is highly prevalent in individuals aged older than 65 years, affecting between 32% and 68% of that population.
The patient in the pictures complained for severe back pain, fatigue and an inability to do daily activities. At the time of presentation, standard radiographs showed a severe sagittal with a stiff lumbar curve.
The spino-pelvic parameters showed a mismatch between the lumbar lordosis and the ideal one of almost 50 degrees.
Surgery was suggested with the aim to correct the lack of lumbar lordosis.
A corner pedicular subtraction osteotomy (modified PSO) was performed, that consists in removing the posterior vertebral arch, the pedicle and the posterior-superior corner of the vertebral body; the inferior endplate of the vertebra above is prepared and the superior adjacent disc removed to obtain, when closing the osteotomy, a direct interbody fusion.
The postoperative X-Ray showed a proper sagittal and coronal alignment with a normative lumbar lordosis achieved. 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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