Adolescent Idiopathic Scoliosis Case 19

Case Review #19: Adolescent Idiopathic Scoliosis from Robert Pashman

A 17 year old female with Progressive Adolescent Idiopathic Scoliosis. Dr. Pashman performed a Posterior Spinal Fusion T4-L4.

    Case Review:

    17 year old female with progressive Adolescent57° Idiopathic Scoliosis, followed for six years prior to surgery.

    Patient History:

    18 year old female
    Followed by Dr. Pashman for 5+ years.
    Progressive Adolescent Idiopathic Scoliosis
    Upper back pain and lumbar back pain
    Failed conservative therapy

    Pre-op X-rays:

    Note the progression of the curve on these interval x-rays. The size and rotation of both curves suggest this is a double major curve, not a thoracic deformity with a compensatory lumbar curve.

    Bending X-rays:

    Bending films suggest both thoracic and lumbar structurality indicating that this is a double major curve. Right-side bending revealed that L4 could be centered over the central ala and therefore this was chosen as the distal fusion level.

    Indications for Surgery

    1. Progressive right thoracic Kim SRP2/type 1CN curved adolescent idiopathic scoliosis.
    2. Double major curve with severe rotation thoracic and lumbar component.
    3. Failed conservative therapy with progressive curve, follow time 6 years.
    4. Increasing pain upper thoracic low back pain due to progressive scoliosis.
    5. Element of thoracic kyphosis, adolescent idiopathic scoliosis.

    Surgical Strategy:

    Thoracic 4 to lumbar 4 segmental spinal instrumentation with 5.5 stainless steel pedicle screw/rod construct.
    Posterior spinal fusion, thoracic 4 to lumbar 4, with combination of locally harvested autogenous bone crouton extenders and rhBMP. Multiple level Smith-Petersen osteotomy for duction of flexibility to rigid thoracic component, T5 to T11, that is a 6-level osteotomy.
    Intraoperative OR neuro-navigation.
    Intraoperative somatosensory evoked potential and motor evoked potential interpretation.
    Plastic closure of the wound.

    Post-op Films:

    The patient is well balanced in the sagittal and coronal planes.  A 39° thoracic correction was obtained.   A 52° lumbar correction was obtained.

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