Adolescent Idiopathic Scoliosis Case 6

Case Review #6: 13 year old with Adolescent Idiopathic Scoliosis from Robert Pashman

A 13 year old female presented with Adolescent Idiopathic Scoliosis. The patient was treated with a posterior spinal fusion to correct her curvature.

    Case Review:

    13 year old female, with Adolescent Idiopathic Scoliosis

    Patient History:

    13-year-old female
    52° ICN right thoracic curve from thoracic 4 tothoracic 11.
    Status post menarche
    Failed conservative therapy
    Recent growth spurt
    Has obtained several surgical opinions

    Pre-op X-rays:

    The patient is balanced through T3 through L1, has depression of the left shoulder with a 10° T1 tilt angle. The patient has significant cosmetic deformity with a 2 cm right rib hump, but plumb line middle in its balance in the frontal and sagittal plane. There is no significant sagittal component

    Indications for Surgery:

    Progressive ICN adolescent idiopathic scoliosis.
    Severe cosmetic deformity with right rib hump.
    Failed conservative therapy.
    Mid thoracic and low lumbar pain.

    Surgical Strategy:

    1. Segmental spinal instrumentation for correction of adolescent idiopathic scoliosis thoracic 3 to lumbar 1 using 5.5 rod, pedicle screw, rod Ultra Steel construct.
    2. Concave osteotomy with removal of ankylosed facet joints T7, T5 through T9 for mobilization of thoracic spine.
    3. Posterior fusion T3 to L1 with locally harvested autogenous and rib bone.
    4. Thoracoplasty right chest wall resection for reduction of cosmetic deformity 5 ribs.
    5. Intraoperative motor evoked potential interpretation with pedicle screw stimulation.
    6. Intraoperative fluoroscopy

    Post-Op Films:

    She is well balanced in both the sagittal and coronal planes.

    Pre-Op/Post-op Comparison:

    The patient’s curve was reduced 100%, from 52° to 0°.  She is doing very well…and anxious to start karate at one year post-op.

Related links:

Scoliosis overview
Adolescent Idiopathic Scoliosis
Adult 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