Adolescent Idiopathic Scoliosis Case 20

Case Review #20: 15 year old female with Adolescent Idiopathic Scoliosis from Robert Pashman

A 15 year old female with Progressive Adolescent Idiopathic Scoliosis. Dr. Pashman performed a Posterior Spinal Fusion T3-L3.

    Case Review: 

    15 year old female with progressive Adolescent Idiopathic Scoliosis, triple curvature.

    Patient History:

    The patient presented at age 13, when scoliosis was detected during routine school screening.
    Post-menarchal female
    Type 6 curve or primary thoracolumbar curve with significantly rotated and structural thoracic component.
    She also has some asymmetry of her shoulders.
    The patient has a 1 cm leg length inequality
    Patient followed for two years prior to surgery.

    Pre-op X-rays:

    The patient seems to be decompensated slightly in the coronal plane. She has a hyper thoracic kyphosis, compensatory lumbar lordosis.  She was significantly worked up to verify that this is an idiopathic curve, not a congenital curve.

    Bending X-rays:

    Right and left side bending show a horizontality of L3 on the Harrington drop line specifically with bending

    Indications for Surgery:

    1. Progressive adolescent idiopathic scoliosis type 6 curve T2 to T5 of 24°, T6 to T9 of 41°, and T10-L5 of 51° respectively.
    2. Progressive deformity despite conservative therapy.
    3. Intermittent upper and low back pain.

    Surgical Strategy:

    Thoracic 3 to lumbar 3 segmental spinal instrumentation using pedicle screw rod construct, stainless steel, 1/4-inch.
    Posterior spinal fusion thoracic 3 to lumbar 3 using locally harvested autogenous bone and allograft extender.
    Bilateral facetectomy and osteotomy for partially ankylosed spine thoracic 4 to thoracic 10.
    Induction of flexibility with radical facetectomy thoracic 12 to lumbar 2.
    Interlaminar decompression for visualization of pedicles, L1-2, L2- 3 on the left.
    Intraoperative fluoroscopy.
    Intraoperative somatosensory evoked potentials and motor evoked potentials.

    Post-op Films:

    The hardware in excellent position, and over 50% correction of her curve was obtained.  However, we can see that her head is shifted slightly to the right and she has some obliquity of her pelvis. Dr. Pashman recommended a heel lift to address the patient’s leg length discrepancy.

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