Case Reports
. Oct-Dec 2021;12(4):432-436.
doi: 10.4103/jcvjs.jcvjs_121_21.
Epub 2021 Dec 11.
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Case Reports
J Craniovertebr Junction Spine.
Oct-Dec 2021.
Abstract
In adult degenerative spondylosis, much emphasis has been placed upon recognizing the sagittal plane deformity and techniques to restore this alignment. However, the coronal plane deformity has not received much attention and, if left uncorrected, may lead to poorer outcomes. Here, we present a case of degenerative lumbar scoliosis with a rigid coronal malalignment secondary to a dysplastic sacrum. We performed staged T11-pelvis lateral and posterior approach to address this deformity. For the first stage, a lateral lumbar interbody fusion was performed at the concavity of the curve from L3 to L5. For the second stage, through posterior approach, a long-segment instrumentation from T11 to pelvis was done along with bilateral asymmetrical posterior lumbar interbody fusion of L5-S1 to level the L5 vertebra at the hemi-curve, thereby leveling the coronal deformity. We propose, for cases with a rigid coronal deformity due to bony dysplasia, correction through the disc space using asymmetrical interbody cages as in this case offers the surgeon an option to achieve a desired correction, without the need for vertebral osteotomy.
Keywords:
Deformity; lumbar vertebrae; scoliosis; spinal fusion; spondylosis.
Copyright: © 2021 Journal of Craniovertebral Junction and Spine.
Conflict of interest statement
There are no conflicts of interest.
Figures
Figure 1
Preoperative standing X-rays showing Grade 1 L4-L5 spondylolisthesis, sagittal vertical axis of 12 cm, pelvic incidence of 58°, pelvic tilt of 31° and lumbar lordosis of 16° (L1–L5). Standing scoliosis X-rays demonstrate Nanjing Type C, Obeid Type 2A2 coronal curve
Figure 2
(a) Preoperative computed tomography of lumbar spine demonstrating the oblique sacral tilt with symmetrical L5–S1 disc space, resulting in a tilted L5 vertebral body that was the main driver of his scoliosis. (b) Preoperative magnetic resonance sagittal image of the lumbosacral spine showing multilevel spinal stenosis
Figure 3
(a) Asymmetrical L3–L4 and L4–L5 disc spaces contributing to coronal deformity, (b) after stage 1 (lateral lumbar interbody fusion), coronal imbalance progressed due to the existing sacral tilt
Figure 4
(a) Coronal imbalance secondary to oblique sacrum take off, resulting in tilted L5 vertebral body. (b) Bilateral wide decompression and asymmetric distraction using a screw-based distractor, to horizontalize L5 superior endplate. (c) Bilateral PLIF cages used to maintain correction and prevent point loading, with T11–pelvis instrumentation
Figure 5
Sixth-month postoperative X-rays – Scoliosis long films and thoracolumbar anteroposterior and lateral views
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