Adolescent Idiopathic Scoliosis Case 16

Case Review #16: 16 year old male with Highly Rotated Adolescent Idiopathic Scoliosis from Robert Pashman

A 16 year old male, with a highly rotated thoracolumbar Adolescent Idiopathic Scoliosis. Dr. Pashman performed a Posterior Spinal Fusion T10-L3.

    Case Review:

    16 year old male with Adolescent Idiopathic Scoliosis and a highly rotated thoracolumbar curve.

    Patient History:

    16½ year old male.
    Presented with a 42° right T4-T11, 58° left T11-L3 with a thoracolumbar kyphosis.
    At six month follow-up appointment, the cures had progressed to 58° T4-T11 right, 69° left T11-L3
    This is a progressive type 6C C curve which shows an increasing highly rotated thoracolumbar curve to the left with a compensatory right thoracic curve.
    The patient reports minimal pain.
    He is an avid tennis player.

    Pre-op X-rays:

    The patient has a hint of thoracolumbar kyphosis which is probably due to progressive rotation, as the coronal plane rotated into the saggital component.
    The patient is decompensated approximately 2cm to the left of plum line.
    The patient has slight depression of his left shoulder.

    Bending X-rays:

    The bending films show L3-S1 strained significantly on right side bending and the proximal thoracic curve bends to 10 degrees on right-side bending. The lumbar curve bends out at 20° on left side bending.

    Indications for Surgery:

    1. Progressive adolescent idiopathic scoliosis, type 5C/6C, 58° left thoracolumbar curve.
    2. Progressive deformity with right rib and left flank fullness.
    3. Increasing low back pain with increasing deformity and rotation.
    4. Failed conservative therapy.

    Surgical Strategy:

    Segmental spinal instrumentation T10-L3 using 5.5 stainless steel pedicle screw rod construct.
    Posterior spinal fusion T10-L3 using locally harvested autogenous bone and RH BMP.
    Multiple level osteotomy for increase of flexibility T12-L2 with bilateral takedown of facet joints.
    Neuronavagation with placement of percutaneous pin reference framing, left iliac crest.
    Intraoperative SSEPs.

    Post-op Films:

    The patient is well balanced in both the frontal and sagittal planes.  He plum lines with his head directly over his hips.  His rib hump was reduced with surgery.

    Related links:

    Scoliosis overview
    Adolescent Idiopathic Scoliosis
    Adult Idiopathic Surgical Cases performed by Dr. Pashman
    Patient journal of scoliosis surgery, Patient follow-up journal four years after surgery
    Bracing for Scoliosis
    Scoliosis FAQ’s
    Books about Scoliosis