History

A 33 year old female with a history of scoliosis diagnosed in adolescence presented with complaints of severe, progressive lower back pain and left lower extremity pain, numbness and tingling.

Non-operative treatment included: activity modification, physical therapy, therapeutic massage, chiropractic manipulation, oral pain medications (including NSAIDs and narcotics), and epidural steroid injections.

Examination

On examination, she was found to have a scoliotic deformity, lumbar spinal rotation, uneven shoulder height (left slightly higher than right) and positive sciatic nerve stretch testing of the left lower extremity.

Scoliosis radiographs revealed a high magnitude adult scoliotic deformity with progression. At the time of presentation her L1 to L4 left lumbar curve measured 58 degrees and her lumbar lordosis from L1 to L5 measured 30 degrees.

Pre-treatment Scoliosis X-rays

Diagnosis and Pre-operative MRI

Her pre-operative MRI revealed a scoliotic deformity. At L5-S1 she had a large foraminal disc herniation on the left side at L5-S1, which obliterated the neural foramen and compressed the left L5 nerve root.

She was diagnosed with scoliosis and a lumbar herniated disc causing an L5 sciatica / radiculopathy (pain) due to the severe neuroforaminal stenosis (narrowing) at L5-S1 and compression of the exiting L5 nerve root.

Selected Treatment

The patient underwent a T10 to S1 posterior spinal fusion with scoliosis correction and left sided L5-S1 nerve decompression with Transforaminal Lumbar Interbody Fusion (TLIF).
This procedure allowed for improved sagittal and coronal alignment and created more space for the L5 nerve root to exit the spine without being impinged.

Post-operative Image/Pre-operative Image Comparison

Outcome

After discharge from the hospital, she commenced outpatient formal physical therapy and returned to work and full activities. Post-operatively she reported full resolution of both her lower back pain and lower extremity symptoms.

 
 
 
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