Adolescent Idiopathic Scoliosis Case 23

Case Review #23: 15 year old male with Adolescent Idiopathic ScoliosisScoliosis from Robert Pashman

A very active 15 year old male presented with progressive Adolescent Idiopathic Scoliosis. His curve progressed after a recent growth spurt. The patient had scoliosis surgery, and returned to ROTC.

    Case Review:

    15 year old male with progressive Adolescent Idiopathic Scoliosis

    Patient History:

    15 +7-year-old Risser 4 male
    Progressive Adolescent Idiopathic Scoliosis
    Very active student, ROTC participation
    Recent growth spurt
    No other contributing medical conditions.

    Pre-op X-rays:

    The patient is a Risser 4.  The characteristics of the curve are a rigid right thoracic curve, a significantly rotated lumbar curve with a significant thoracolumbar kyphosis measuring 30°.

    Bending Films:

    On the right-sided lumbar side bending the patient displays neutrality as the midline bisects Harrington neutral vertebral rotation between the L3-4 disk. The thoracic right side bending is structural to about 36 degrees. Left side bending shows a significant flexibility of the lumbar component which reduces to approximately 20 degrees the apex L2-3 is still rotated and does not neutralize until the L3-4 disk.

    Indications for Surgery:

    1. Lenke 1C versus 3, 51 degree right thoracic, 48 degree left lumbar curve progressive adolescent idiopathic scoliosis.
    2. A 3 cm right rib hump left flank fullness.
    3. Progressive deformity with failed conservative therapy in a adolescent.

    Surgical Strategy:

    Thoracic 3 to lumbar 3 segmental spinal instrumentation using ¼ inch stainless steel rod screw construct.
    Posterior spinal fusion thoracic 3 to lumbar 3 using locally harvested autogenous bone with allograft extender.
    Multiple level Smith-Petersen osteotomy for induction of flexibility and cosmetic result.
    Thoracic 6 to lumbar 1 bilateral facetectomy and midline takedown.
    Intraoperative OR neuro navigation.
    Intraoperative motor evoked potential interpretation.
    Intraoperative plastic closure.

    Post-op Films: 

    The patient did very well post-operatively, and returned to school after a couple of weeks.

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