Adolescent Idiopathic Scoliosis Case 24

Case Review #24: A 15 Year Old Female with Adolescent Idiopathic Scoliosis from Robert Pashman

Dr. Pashman followed the patient for three years. After a growth spurt, her scoliosis curvature progressed significantly, and she required scoliosis surgery.

    Case Review:

    15 year old female with progressive Adolescent Idiopathic Scoliosis

    Patient History:

    15-year-old female
    Progressive Adolescent Idiopathic Scoliosis
    The patient was followed for 3 years
    The patient had a recent growth spurt
    The patient has a significant rib hump

    Bending X-rays:

    61-degree right thoracic, 55-degree left lumbar curve and can be described as a Lenke 1C versus 3 curve, most likely a 1C curve because right and left side bending show the lumbar compensatory component does reduce less than 25, although the curve magnitude ratio is 1.2 and rotation radius ratio is 1.0. moreover, the deviation from midline is almost parity and therefore there was a significant amount of thought put into what fusion levels should be done

    Indications for Surgery:

    1. Lenke 1C versus 3, 61-degree right thoracic, 55-degree left lumbar progressive adolescent idiopathic scoliosis.
    2. Significant cosmetic deformity with 3-cm right rib hump and left flank fullness.
    3. Progressive deformity failed conservative therapy in a post menarchal adolescent.

    Surgical Strategy:

    Thoracic 3 to lumbar 3 segmental spinal instrumentation using 5.5 stainless steel rod screw construct.
    Posterior spinal fusion thoracic 3 to lumbar 3 using locally harvested autogenous bone with autograft plus rib graft.
    Multiple level Smith-Petersen osteotomy for induction of a flexibility and cosmetic result.
    Smith-Petersen osteotomy for induction of flexibility thoracic 6 to lumbar 1, bilateral facetectomy and midline takedown.
    Intraoperative O-arm neuro navigation.
    Intraoperative motor evoked potential interpretation and right chest wall removal thoracoplasty with 6 ribs removed using autogenous bone graft for reduction of rib hump and induction of flexibility.

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