Adolescent Idiopathic Scoliosis Case 18

Case Review #18: 20 year old Female with Adolescent Idiopathic Scoliosis from Robert Pashman

The patient presented at age 16 with a 47 degree curvature. Dr. Pashman followed the patient, and gave her the option to delay surgery until she was out of high school. At age 20 she underwent surgery to correct her spinal curvature.

    Case Review:

    20 year old female, with progressive Adolescent Idiopathic Scoliosis

    Patient History:

    20-year-old female.
    Presented at age 16 with a 47° curvature.
    She has a 2 cm right rib hump, no left lumbar fullness.
    The patient has been followed by Dr. Pashman for several years, and deferred surgery until she was out of high school.

    Pre-op X-rays:

    Progressive 60° right thoracic curve. The patients lumbar curve is minimally rotated and the secondary curve starts at approximately T11-T12.

    Bending X-rays:

    The proximal curve is somewhat rigid with a 30- degree proximal curve and balanced shoulders indicating that there is no significant depression of the left shoulder indicating a non-compensated curve.  Therefore, the fusion levels were chosen for classical distribution on the right thoracic curve letting the lumber curve bend out and be compensatory and flexible.

    Indications for Surgery:

    1. Progressive adolescent/adult idiopathic scoliosis, 60° right thoracic type 1 curve.
    2. Progressive curvature interval conservative treatment.
    3. Thoracolumbar pain due to progressive deformity.

    Surgical Strategy:

    Thoracic 3 to thoracic 12 posterior instrumented fusion using 5.5 pedicle screw rod construct.
    Posterior spinal fusion T3-T12 using combination of locally harvested autogenous bone, allograft croutons and RH BMP.
    Bilateral Smith-Peterson osteotomy to induce flexibility at T5- T11 with radical facetectomy, bilateral and central decompression.
    Intraoperative O-arm neuro navigation.
    Plastic closure of wound.

    Post-op Films:

    The patient is well balanced in both the sagittal and coronal planes.  A correction of 43° was obtained in the thoracic curve, and 25° in the lumbar curve.

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