Adolescent Idiopathic Scoliosis Case 7

Case Review #7: Progressive Adult Idiopathic Scoliosis with a 75 degree curvature from Robert Pashman

A 19 year old female presented with progressive Adult Idiopathic Scoliosis. The spinal curvature progressed, and the patient required spinal reconstructive surgery.

    Case Review:

    Progressive Adult Idiopathic Scoliosis with a 75° Curve

    Patient History:

    19-year-old female
    Type 1AN right thoracic curve
    Curve has progressed significantly from 2003 originally measured at 50°, now is 75° curve with depression of the left shoulder, no compensatory proximal curve. This is a pure thoracic scoliosis .This curve is highly rotated causing significant cosmetic deformity.
    She has a significant 3-cm right rib hump but no left flank fullness.The patient is flexible on right-side bending.
    Neurologically intact.She had significant pain mid thoracic spine in Poland, and had a CT scan. The CT scan to my observation did not show a significant abnormality; this is an idiopathic curve.

    Pre-op X-rays:

    The patient’s curvature had increased 21° over a four year period. When she presented to our office, she was experiencing significant thoracic pain.

    Bending X-rays:

    Bending films show that the patient’s curve is rigid and will require osteotomies for correction.

    Indications for Surgery:

    A 75° right Type 1BN progressive adult idiopathic scoliosis.
    Thoracolumbar kyphosis.
    Rigid deformity, with significant cosmetic deformity and rib hump.
    Failure of conservative therapy

    Surgical Strategy:

    Segmental spinal instrumentation, thoracic 3-lumbar 1, using the quarter-inch stainless steel pedicle screw-rod construct.
    Posterior spinal fusion using locally harvested autogenous bone from thoracoplasty and local bone T3-L2.
    Spinal osteotomy for mobilization of rigid scoliosis, thoracic 4-5, 5-6,6-7, 7-8, and 8-9; these are Ponte osteotomies.
    Thoracoplasty with removal of hemi-chest wall, ribs.
    Intraoperative somatosensory evoked potential, motor evokedpotentials.
    Intraoperative fluoroscopy.

    Post-Op Films:

    The spine was left in a balanced position, in both planes. The lumbar spine did not need to be fused, preserving full motion of the spine. Note the balance in Frontal and Sagittal planes.

    Pre-Op/Post-op Comparison:

    A 43° correction was obtained. The patient has done remarkably well following surgery, and was happy to regain some height. She has resumed her preoperative activities, with all restrictions lifted at 12 months post-operatively.

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