Adolescent Idiopathic Scoliosis Case 2

Case Review #2: A 20 year old female with Adolescent Idiopathic Scoliosis followed for six years from Robert Pashman

    Case Review:

    A 20 year old female with Adolescent Idiopathic Scoliosis followed for six years

    Patient History:

    A 19 year old female with progressive adolescent idiopathic scoliosis. The curvature progressed from 40° to 51° despite bracing. Dr. Pashman performed a posterior spinal fusion T2-L1.

    1. 51° Case Review: Adolescent Idiopathic Scoliosis Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
    2. Patient HistoryThe patient presented in April 2001 with AdolescentIdiopathic Scoliosis, 40° curvature.The patient has juvenile diabetesThe patient was followed from 2001 to 2006. In thattime, the curve progressed from 40° to 51°.Significant thoracic painRib hump and Cosmetic deformity
    3. Curve Progression In April 2001, the patient presented in with Idiopathic Scoliosis, with a 40° curvature, insulin dependent diabetes At 1 year check-up in March 2002 , patient had 41° curvature In June 2003 – 2 cm right rib hump with significant rotation. 36×14 x-rays now reveal a 45° curve At 6 month check-up in November 2003 – 45° curvature In March 2005 – significant cosmetic deformity, curvature of 48° In May 2006 – 48° curve November 2006 – 51° curve, classified as a Lenke 2AN 40° 41° 45° 45° 48° 48° 51°April 2001 March 2002 June 2003 Nov 2003 March 2005 May 2006 Nov 2006
    4. 51° 45°March 2005 May 2006
    5. Bending Films The patients left side bender shows that the proximal curve bent down to approximately28° which constitutes double thoracic curves, specifically because the right shoulder is depressed. I think that the instrumentation should be carried to approximately T2 or T3,so that her shoulders will be level, and this was explained to her. The thoracic curve isflexible to approximately 31°.
    6. Rotation and Lordosis Initiating Factor in Adolescent Idiopathic Scoliosis
    7. Indications for surgery The patient is a 19-year-old female with progressive adolescent idiopathic scoliosis. This is a double major rigid curve, 51°. The proximal curve, which is 35°, bends out to 28°, which constitutes a structural proximal thoracic curve. This necessitated instrumentation up toT2 or T3 to correct the proximal curve so that the shoulders and pelvis could become balanced.A 51°Lenke 2AN progressive, double thoracic scoliosis.Rigid deformity, failed conservative therapy.Significant thoracic pain secondary to scoliosis and spinal deformity.Rib hump.
    8. Surgical Strategy Segmental spinal instrumentation for correction of thoracic scoliosis, T2 to L1 (eleven levels).Posterior spinal fusion, T2 to L1.Concave osteotomy at T4, T5, T6, T7, T8 and T9, for correction of rigid thoracic scoliosis.Local autogenous bone graft harvesting. Intraoperative motor evoked potentials. Intraoperative fluoroscopic control.
    9. Post-Op X-Rays She is very well balanced in the frontal and sagittal plane and has no residual rib hump or deformity. January 2007
    10. X-Ray comparison Her 36×14 x- rays show her curve to be corrected from approximately 51° to 10°.51° 10° May 2006 January 2007