Adolescent Idiopathic Scoliosis Case 22

Case Review #22: 21 year old with Progressive Adolescent Idiopathic Scoliosis from Robert Pashman

A 21 year old female presented to Dr. Pashman with Progressive Adolescent Idiopathic Scoliosis. The patient had been followed for scoliosis, and was compliant wearing her brace. Her spinal curvature progressed despite physical therapy and bracing. Dr. Pashman treated her with a Posterior Spinal Fusion T3-L1.

    Case Review:

    21 year old female with Progressive Adolescent

    Patient History:

    21 year old female
    Followed for Adolescent Idiopathic Scoliosis
    She has noticed that the curve has gotten bigger, and that she has lost height
    Intermittent low back pain

    Pre-op X-rays:

    The patient has depression of her left shoulder, approximately 5 degrees. The patient has global truncal shift 2 cm. She has a right thoracic curve that measures 54 degrees, a compensatory left lumbar curve that measures 27.5 degrees of proximal thoracic curve that measures 31 degrees.

    Bending X-rays:

    The left- sided bending films shows that the L1 vertebra and T12 vertebrae go all way up to neutrality. On left-sided bending the right thoracic curve is flexible to approximately 38 degrees.

    Indications for Surgery:

    1.Adult idiopathic scoliosis.
    2.Progressive adult/adolescent idiopathic scoliosis Lenke type 1A,
    3.Failed conservative therapy including bracing.
    4.Now with progressive deformity upper and lower back pain.
    5.Elevation right rib cage.

    Surgical Strategy:

    Segmental spinal instrumentation thoracic T3-L1 using 1/4-inch stainless steel pedicle screw/rod construct.
    Posterior spinal fusion thoracic 3 to L1 using locally harvested autogenous bone and morselized allograft.
    Multiple level spinal osteotomy for induction of flexibility for correction of Lenke 1A curve.
    Intraoperative O-Arm neuronavigation.
    Intraoperative somatosensory evoked potentials and motor evoked potentials supervision.

    Post-op Films:

    The patient is perfectly balanced in both the sagittal and coronal plane.

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