Adolescent Idiopathic Scoliosis Case E

Case Review #E: 12 year old female with Lumbar Adolescent Idiopathic Scoliosis from Robert Pashman

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.

  1. Case Review: Adolescent Idiopathic Scoliosis treated with an anterior spinal fusion27° Robert S. Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
  2. 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.
  3. 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.
  4. 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.
  5. Indications for surgery1. Progressive Lumbar Adolescent Idiopathic Scoliosis, with curvature 65+ degrees2. Low Back Pain3. Thoracolumbar Kyphosis
  6. 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.
  7. Surgical outcome 27°
  8. 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°
  9. Pre-Post surgery X-ray comparison