Adolescent Idiopathic Scoliosis Case 14

Case Review #14: 16 year old female with progressive adolescent scoliosis from Robert Pashman

A 14 year old female presented for a second opinion for Adolescent Idiopathic Scoliosis treatment. The patient wore a brace and Dr. Pashman observed the curve for two years before recommending surgery.

    Case Review:

    16 year old female with Progressive Adolescent Idiopathic Scoliosis

    Patient History:

    14 year old female presented with progressive Adolescent Idiopathic Scoliosis. Her curve was thought to have increased20° over the duration of her treatment. The patient wore a brace.When she presented at my office, her curve was 40°.  Curve progressed to 46° two years from initial consultation. The patient has 2-cm right rib hump, minimal left lumbar fullness and what appears to be a gross thoracic shift to the right.

    Pre-op X-rays:

    46° 1AN curve with apex at T10, which is fully flexible. The patient has a significant right rib hump.

    Indications for Surgery:

    1. Progressive adolescent idiopathic scoliosis, 1AN, 46 degree, right thoracic curve.
    2. Significant pain, thoracic and lumbar spine.
    3. Cosmetic deformity of thoracic spine.
    4. Failed conservative therapy.

    Surgical Strategy:  

    Segmental spinal instrumentation, T2 to L1 using 5.5 stainless steel pedicle screw rod construct.Multiple level osteotomies, T5 to T10, including Smith-Peterson osteotomies for induction of flexibility for improvement of adolescent idiopathic scoliosis.Posterior spinal fusion, T3 to L1, using locally harvested autogenic bone and allograft.  Removal of fractured facet under loupe magnification, T7 on the left.Plastic closure of the wound.  Intraoperative SSEP management.  Intraoperative fluoroscopy management.

    Post-Op Films:

    The patient is well balanced in the coronal and sagittal planes.

    Pre-Op/Post-op Comparison: 

    The patient’s symptoms resolved following surgery, and she is very happy with her cosmetic outcome.

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