eSpineA 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