eSpineA very active 15 year old male presented with progressive Adolescent Idiopathic Scoliosis. His curve progressed after a recent growth spurt. The patient had scoliosis surgery, and returned to ROTC.
Case Review:
15 year old male with progressive Adolescent Idiopathic Scoliosis
Patient History:
15 +7-year-old Risser 4 male
Progressive Adolescent Idiopathic Scoliosis
Very active student, ROTC participation
Recent growth spurt
No other contributing medical conditions.
Pre-op X-rays:
The patient is a Risser 4. The characteristics of the curve are a rigid right thoracic curve, a significantly rotated lumbar curve with a significant thoracolumbar kyphosis measuring 30°.
Bending Films:
On the right-sided lumbar side bending the patient displays neutrality as the midline bisects Harrington neutral vertebral rotation between the L3-4 disk. The thoracic right side bending is structural to about 36 degrees. Left side bending shows a significant flexibility of the lumbar component which reduces to approximately 20 degrees the apex L2-3 is still rotated and does not neutralize until the L3-4 disk.
Indications for Surgery:
1. Lenke 1C versus 3, 51 degree right thoracic, 48 degree left lumbar curve progressive adolescent idiopathic scoliosis.
2. A 3 cm right rib hump left flank fullness.
3. Progressive deformity with failed conservative therapy in a adolescent.
Surgical Strategy:
Thoracic 3 to lumbar 3 segmental spinal instrumentation using ¼ inch stainless steel rod screw construct.
Posterior spinal fusion thoracic 3 to lumbar 3 using locally harvested autogenous bone with allograft extender.
Multiple level Smith-Petersen osteotomy for induction of flexibility and cosmetic result.
Thoracic 6 to lumbar 1 bilateral facetectomy and midline takedown.
Intraoperative OR neuro navigation.
Intraoperative motor evoked potential interpretation.
Intraoperative plastic closure.
Post-op Films:
The patient did very well post-operatively, and returned to school after a couple of weeks.
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