Adolescent Idiopathic Scoliosis Case D

Case Review #D: 16 year old female with Adolescent Idiopathic Scoliosis from Robert Pashman

A 16 year old female with Adolescent Idiopathic Scoliosis. Her curve progressed to 50° despite bracing. Dr. Pashman treated her with an Anterior Interbody fusion from T11 to L3.

  1. Case Review: Adolescent Idiopathic Scoliosis in a 16 year old female.50° Robert S Pashman, MD Scoliosis and Spinal Deformity www.eSpine.com
  2. Patient History16-year-old femaleFollowed for scoliosis for quite some time.Curve progressed despite wearing a brace.Progressive spinal deformity and significant thoracolumbar pain.She reports neck, back pain with radiation intermittently to the leftarm, bilateral upper extremity numbness, tingling in spinal area, lowback and left arm although this is not constant. She has no othernon-idiopathic concordant signs for scoliosis.Shoulders and hips are level. She is slightly decompensated in thecoronal plane but well-balanced in the sagittal plane.Significant left-sided elevation of her flank and slight right rib hump.
  3. Pre-op X-rays The 36X14 x-rays show that she has a 50° left lumbar curve with apex in the proximal lumbar spine with significant rotation and a compensatory thoracic curve. She has significant lumbosacral obliquity but this is no doubt due to the thoracolumbar curve and the rest of the frontal and sagittal plane50° deformity is well balanced. She has no sagittal plane deformity.
  4. L L Bending X-Rays Right/left bending indicated that the T11 to L3 anterior transvertebral fixation would be best to conserve levels, the proximal curve being inL L excess of 40°, bent down to 33° and is not rotated indicating true compensatory curve. The patient is well- balanced over the sacral ala with plumb and straight line. At this point, the patients balance will be taken into consideration.
  5. Indications for SurgeryAdolescent idiopathic scoliosis.Thoracolumbar 50° scoliosis with compensatory curve in thethoracolumbar spine.Failed conservative therapyCurvature progressionStatus post conservative treatment; bracing with failure to stop curveprogression.Low back pain
  6. Surgical StrategySegmental spinal instrumentation thoracic 11 to lumbar 3-5 level usingtransvertebral Legacy screw, rod and staple construct.Anterior interbody fusion with PEEK device with autogenous bonegraft, L1-2 and L2-3.Radical diskectomy with spinal canal decompression T11-12 to L2-3-4level.Anterior interbody fusion with autogenous rib graft T11 to L3. This is 4levels.Harvest autogenous rib graft.Thoracoabdominal approach T11 on the left.Motor evoked potentials.Plastic closure.Anterior vertebrectomy, subtotal L1 and T12 for harvestingautogenous bone graft.
  7. Post-Op X-raysNo pain. Balance is excellent.Curve has been reduced almost 60%.Her balance is excellent.She is very pleased with her outcome.
  8. X-ray comparison50° 20°