A 12 year old female from Alaska presented with Lumbar Adolescent Idiopathic Scoliosis. She had a 65° curve and Dr Pashman treated her with an Anterior Interbody fusion T11-L3.
- Case Review: Adolescent Idiopathic Scoliosis treated with an anterior spinal fusion27° Robert S. Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
- Patient history 12 year-old female from Alaska Post menarche Progressive Adolescent Idiopathic Scoliosis Denies back pain or lower extremity symptoms The patient was found to have scoliosis on an x-ray of herthoracolumbar spine during a routine examination of her knee. She has had brief growth spurt and no other medical problems.The patient is decompensated to the left somewhat per gross obesity.She does have a little bit of right thoracic prominence and has a largelumbar fullness. She has a certain amount of kyphosis in thethoracolumbar junction. The leg lengths are almost equal. Motorsensory examination intact. No skin markings, tags are non-idiopathicsuggestions for scoliosis.
- Pre-op x-rays The patients 36 x 14 x-rays reveal a 65° left lumbar curvature. She has significant tilting of L4, L531° but on the right side bending corrects to the midsacral line up to L4. 65° L3 is still left of the midsacral line. The patients upper thoracic region does not indicate significant rotation or scoliosis, although she does have a right rib hump.
- Bending x-rays L RBending x-rays are taken to: Predict flexibility of all curves. Lessflexible curves are termed structural and need to be fused. More flexiblecures are termed compensatory.
- Indications for surgery1. Progressive Lumbar Adolescent Idiopathic Scoliosis, with curvature 65+ degrees2. Low Back Pain3. Thoracolumbar Kyphosis
- Surgical strategy and procedure1. Left T11 transthoracic retroperitoneal exposure of thoracolumbar spine.2. Complete diskectomy, T11-12, T12-L1, L1-L2 and L2-L3.3. Anterior interbody fusion, T11-12, T12-L1, L1-L2 and L2-L3.4. Segmental spinal instrumentation, T11 to L3, with transvertebral Isola stainless steel rod and staple construct.5. Intraoperative somatosensory evoked potential monitoring. I did warn them that the possibility of decompensation or non- correction of the fractional lumbar curve would require further surgery but I think it is in the best interest of the patient to preserve the L3-4, L4-5 motion segments.
- Surgical outcome 27°
- Pre-Post surgery X-Ray comparison 38° correction was obtained. The patient did very well31° post-operatively, and returned to Alaska two weeks after surgery. 65° 27°
- Pre-Post surgery X-ray comparison