Chronic Thoracolumbar Pain Following Extensive 16-Level Spinal Fusion in a Patient With Juvenile Idiopathic Scoliosis: A Case Report

Case Diagnosis: 16-level spinal fusion in 25-year-old male with juvenile idiopathic scoliosis.

Case Description or Program Description: The patient presented with progressive thoracolumbar pain after a motor vehicle accident. Multi-faceted treatment modalities were started which included physical therapy, multiple pharmacologic regimens, various injection therapies, and spinal cord stimulation, all of which provided only temporary relief. Due to continued struggles with movement and increasing pain, the patient elected to undergo a 16-level spinal fusion from T3 to the ilium with Ponte osteotomies for realignment. Postoperatively, the patient continues to experience pain, decreased mobility, and minimal improvements in overall quality of life.

Setting: Pain management and rehabilitation.

Assessment/Results: The patient’s post-fusion rehabilitation revealed persistent pain and functional impairment, with adjacent segment disease and potential pseudoarthrosis as contributing factors. Though there are improvements in spinal stability and posture, long-term pain control and mobility challenges persist. Ongoing evaluation is focused on assessing the efficacy of additional rehabilitative and adjunctive interventions.

Discussion (relevance): This case explores the complexities of post-fusion rehabilitation in patients undergoing multi-level spinal fusions. It highlights the difficulties both patient and physician face in navigating the prior treatment efficacies, potential adjunctive therapies, and long-term rehabilitation needs. Identifying gaps in current management strategies is crucial for optimizing patient outcomes. Patients considering multi-level spinal fusions should be counseled on potential long-term complications, which include persistent pain and reduced mobility.

Conclusions: Comprehensive, multidisciplinary medical teams are essential to creating positive outcomes for extensive spinal fusion procedures. This case highlights the need for individualized treatment approaches for pain management, and the patient’s overall well-being. Further research is necessary to help refine pain protocols and improve long-term outcomes for patients undergoing such extensive spinal fusions.