Is the Short Posterior Stabilization by TLIF and Cages A Good Way for A Correct Spinal Alignment in the De Novo Scoliosis? A Case Report

Scoliosis is a medical condition in which a person’s spinal axis has a three-dimensional deviation. The main diagnostic criterion is spinal curvature exceeding 10° on a plain antero-posterior X-ray image. Scoliosis can occur before skeletal maturity and persist over time (idiopathic scoliosis) or it can occur in adulthood (de novo scoliosis). “De novo scoliosis” is due to disc degeneration, osteoporosis, and osteoarthritis of the facet joints.“Idiopathic scoliosis” represents temporal continuity of a spinal deformity, and is already present in prepuberty or adolescence. It normally becomes symptomatic with disc degeneration. Although the etiology of these conditions is different, they can coexist and overlap .The incidence of scoliosis in people over fifty years of age is 6 percent, and in patients over fifty years of age with osteoporosis or osteomalacia, the incidence is six times greater and there is a higher risk of health problems in adult life, decreased quality of life, cosmetic deformity and visible disability, pain and progressive functional limitations . We reported a case of de novo scoliosis treated with short stabilization technique and TLIF in accord with Harms and Jeszensky.

Case Presentation

Our patient,a74 year old retired bank worker, came to the center of our Spine Surgery AOUS University Policlinic “Santa Maria alle Scotte” of Siena, reporting an anamnestic history of backache for 6 months, and was negative for idiopathic scoliosis. He reported an ingravescent limitation in the performance of daily activities. Pain measured by VAS scale was an 8,while the Oswestry Low Back Pain Score was 36 points and 46 in SF-36 scale.Upon objective examination the patient had an unnatural upright posture while squatting, and there was a scoliotic deflection along the thoracic, thoraco-lumbar, lumbar, and lower back section, with the presence of a rib prominence. 

The patient also had left radicular syndrome. He had an intermittent claudicatio with pain after 25 meters of walk. The vertebrae with a limiting curve were T12 andL5, while theapical vertebra was L2.X-ray measurement in AP projection (antero-posterior) revealed that the patient had an angle of 22.8° Cobb (between upper surface of T12 and lower of L5) while the LL (latero-lateral) projection (Figure 2) was 15.7° Cobb, with the loss of the physiological lumbar lordosis.