1. Master Meeting: Spinal Deformities
Minneapolis – MN
Renato J. Muniz Teixeira MD
Rio de Janeiro-Brazil

2. Full XR: Adult Degenerative Scoliosis Type V. Apex L2
No Sagittal Imbalance
T12
40º
40º
SS=45º
PI= 85º ( 40-65º)
PT= 40º ( 10-25º)
SS= 45º ( 30-45º)
LL = 40º L5
PT=40º
PI=85º

3. DIAGNOSIS
MR: Multilevel Stenosis. L4-L5 Retrolistesis. L3-L4 Foraminal Stenosis.
L2-L3 Disc Herniation

4. SURGICAL TREATMENT What To Make ? Scoliosis Surgery:
Instrumented Fusion from T10 to L5
Instrumented Fusion from T10 to S1
Instrumented Fusion from T10 and
Sacroiliac Fixation
Anterior Fusion in the Levels:
- L5-S1
- L4-S1
- L4-L5
- L3-L5
All options
Others Options
Nothing
Only DDD Surgery
Scoliosis Surgery

5. PRE-OP IMAGING Female 47 years old Important lumbar pain. VAS 9/10
Without neurologic clinic
VAS 0/10
Scoliosis Deformity in the
Clinical exploration
No reaction at all type of the
Treatment including Pain Unit

6. SURGICAL TREATMENT Surgery 2010/2/22 PLT T10-L5 TLIF L3-L5
The patient gets out of
Hospital in ten days

7. SURGICAL TREATMENT 45 days of the Follow-Up Negative Sagittal Balance
Positive Sagittal
Balance

8. POST-OP EVALUATION What is the Ethiologic? Pull Out S1 Screws
No Sacropelvic Fixation
No S1 Screw and L5-S1 TLIF
Stress Fracture of the L5
No Good Lumbar Lordosis
All the Options
What To Make Now ?
Recolocate the
Implants
L5-S1 double Fusion
Sacropelvic Fixation
Osteotomies
- SP-O
- PSO
All the Options
Retropulsion
L4-L5 Cages
Pull Out S1 Screws

9. Alphatec Spine Aca New Surgery 2010/7/5 Betterr Sagital Balance
Relocation L4-L5 cages
We put S1 screws
We made L5-S1 bone fusion
Sacropelvic Fixation
Seven years of the
Follow up.
The patien is perfect
No more complications
Betterr Sagital
Balance

10. Большое спасибо!