Adult Scoliosis Case 32

Case Review #32: 21 year old male with Adult Idiopathic Scoliosis from Robert Pashman

21 year old male presented with Adult Idiopathic Scoliosis which progressed despite bracing. Dr. Pashman treated the patient with a posterior spinal fusion from T2-L1. Scoliosis curve was a KIM/SRP Classification 1.

    Case Review:

    21 year old male, with Adult Idiopathic Scoliosis which progressed despite bracing.

    Patient History:

    21-year-old male
    Adolescent Idiopathic Scoliosis
    Was braced as a child.  Noticed decreased height. No other medical problems.
    Right rib hump, moderate left lumbar fullness, balanced frontal sagittal plane.
    Motor sensory examinations intact.

    Pre-op X-rays:

    36 x 14 x-rays show a type A/BN curve moderate rotation lumbar spine, 60° curve with 42° lumbar compensatory curve.  The patient has a short right thoracic curve. This will be studied with CT scan to rule out a congenital abnormality, but the patient would benefit from a selective thoracic fusion.

    Bending X-rays:

    On side bending, the patients lumbar spine to the left centers over, on right side bending, T12 comes to the mid- Harrington or mid- gluteal line, but clearly the curve is well left of the mid point. On right side bending, the lumbar curve is significantly flexible from 42° to 27° with significant derotation. The proximal thoracic curve is ridged at 35°, making this a double thoracic curve.

    Indications for Surgery:

    1. 2CN progressive adult idiopathic scoliosis.
    2. Upper thoracic pain.
    3. Thoracic kyphosis.
    4. Rigid curved failed conservative therapy.

    Surgical Strategy:

    The patient has a rigid 60° primary thoracic curve and this will need release. That is why multiple levels osteotomies were done. The plan is T2 to lumbar 1 because the lumbar spine was left free for auto balance.  Segmental spinal instrumentation using a 5.5 stainless pedicle screw, rod construct, thoracic 2 to lumbar 1.  Segmental osteotomy for release of rigid thoracic spine, 60°, T4,T5, T6, T7, T8, T9 and T10.  Posterior spinal fusion, thoracic 2 to lumbar 1, using locally harvested autogenous bone.  Intraoperative SSEPs.Intraoperative fluoro.

    Post-Op Films:

    The patient is well balanced in the sagittal and coronal planes. He was very happy with his outcome. The patient returned to weight lifting and his job in the construction industry one year post-op.

 

Related links:

Scoliosis overview
Adult Idiopathic Scoliosis
Patient journal of scoliosis surgery, Patient follow-up journal four years after surgery
Scoliosis FAQ’s
Books about Scoliosis