Adolescent Idiopathic Scoliosis Case 4

Case Review #4: Adolescent Idiopathic Scoliosis with 61 degree curvature from Robert Pashman

A 22 year old female presented with Adolescent Idiopathic Scoliosis. She was braced as a child, and the curve continued to progress until she required surgical intervention.

    Case Review:

    Adolescent Idiopathic Scoliosis 61° Curvature, Treated with a Posterior Spinal Fusion by Robert S Pashman, MD

    Patient History:

    22-year-old female Adolescent Idiopathic Scoliosis
    Braced as a child, stayed at 36º curvature
    Followed up intermittently
    Presented with a 61º Lenke 1AN curve, with Cobb from T3 to T11. The patient has increasing rib hump. Her height is decreasing. She has pain over the thoracic spine. She has significant thoracic shift to the right. The left shoulder is down. There is significant rotation of the thoracic spine and deformity.

    Pre-op X-rays:

    The lateral x-ray shows she has lumbosacral transitional vertebra and hyperlordosis of the fractional lumbosacral joint, but she has hypokyphosis of the thoracic spine.

    Bending Films:

    On left side bending, the patients proximal curve from T1 to T4 bends out to 40°. This is a non-structural curve. The main thoracic curve bent out to 40° and is somewhat rigid. Left side bending shows that the whole lumbar complex deviates to the left of the midline and his highly flexible. The neutrally rotated vertebra is L1.

    Surgical Strategy:

    Multiple facet osteotomies for mobilization of spine T3 down to L1.
    Micro-decompression T4-5 on the right.
    Bilateral laminectomy T4-5, for fractured facet joint status
    Segmental spinal instrumentation thoracic 2 down to lumbar 1 – 11 level posterior instrument fusion using stainless steel 5.5 pedicle screw rod construct.
    Posterior spinal fusion thoracic 2 to lumbar 1 using combination of locally harvested autogenous bone, RHBMP and allograft putty.

    Post-Op Films:

    Truncal Balance is excellent. She is well balanced in the frontal and sagittal planes. The instrumentation looks like it’s in good position. The patient is happy with her cosmetic outcome, and reports a reduction in her symptoms.

    X-Ray Comparison:

    The curve has been reduced 36% from 61° to approximately 22°.

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