Progressive Post-laminectomy Adult Spinal Deformity: A Case Study With a 24-Year Imaging Span

Adult spinal deformity (ASD) arising after remote lumbar decompression is a recognized but under-reported clinical entity, and its long-term radiographic trajectory in conservatively managed patients is incompletely characterized. We describe a 56-year-old female with chronic axial low back pain who underwent lumbar surgery in November 2001 (presumed decompressive laminectomy) and for whom imaging is available from a standing preoperative radiograph obtained in April 2001 through nine years of serial standing studies obtained between 2016 and 2025. The preoperative film demonstrated no significant lumbar coronal deformity, although its limited field of view could not exclude a thoracic curve. Magnetic resonance imaging in 2014 demonstrated a grade 1 L4-L5 degenerative spondylolisthesis with severe facet arthropathy and mild spinal stenosis. Standing long-cassette radiographs over the subsequent nine years documented progression of a lumbar coronal curve from 35° to 41-43° and the development of a compensatory thoracic curve increasing from 15° to 31°, evolving into a severe S-shaped deformity. The patient was treated initially with a lumbar facet block and ongoing multimodal conservative care. Measurement variability across radiologists, driven by inconsistent end-vertebra selection, limits the strict comparability of these angles and is an under-recognized confounder in real-world deformity surveillance. The case illustrates the tempo of post-laminectomy degenerative scoliosis, highlights the need for standardized standing long-cassette imaging protocols in symptomatic adults with prior decompression, and frames the conservative versus reconstructive decision in light of contemporary ASD evidence.