Adolescent Idiopathic Scoliosis Case 17

Case Review #17: 20 year old female with Adolescent IdiopathicScoliosis from Robert Pashman

A 20 year old female, with Adolescent Idiopathic Scoliosis. She deferred surgery until after college. Dr. Pashman performed a Posterior Spinal Fusion from T3-L1.

    Case Review:

    20 year old female with Adolescent Idiopathic Scoliosis, 58° curvature.

    Patient History:

    The patient was diagnosed with scoliosis at age 16 with a curvature measuring 40°
    Her curvature continued to progress to 50°, and the patient opted to wait until after she graduated from college to proceed with surgery.
    The patient is a top level swimmer and water polo player, and very athletic in general.
    At the time of surgery, she was classified with a Type 2 curve that is 58° right thoracic with a structural upper thoracic curve measuring in excess of 45° with depression of the right shoulder.

    Bending X-rays:

    The patient has flexibility of the lumbar compensatory curve and on right and left side bending compensates well through the L- 1 vertebra. The apex is at T11-10 and the patient has a 2 cm rib hump and was pre-oped for a thoracoplasty pending cosmetic results.

    Indications for Surgery:

    1. Kim/SRP type 1 type 2 adolescent/adult scoliosis, progressive, 58° thoracic curve.
    2. Structural proximal thoracic curve
    3. Documented progression with depression right shoulder.
    4. Increasing upper and low back pain.

    Surgical Strategy:

    Segmental spinal instrumentation thoracic 3 to lumbar 1 using a 5.5 stainless steel pedicle screw rod construct.
    Posterior spinal fusion, thoracic 3 to lumbar 1 using locally harvested autogenous bone, allograft putty and RH BMP.
    Multiple level segmental osteotomy for fractional curve flexibility induction.
    Smith-Peterson osteotomy, T4-5, T5-6, T6-7, T7-8, T8-9, T10-11 and T11-12.
    Intraoperative O-arm neuronavigation.
    Plastic closure of wound.

    Post-op Films:

    A 48° correction was obtained.  The patient is well balanced in both the frontal and the sagittal planes.  She is very happy with the outcome of her 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