Adolescent Idiopathic Scoliosis Case 8

Case Presentation #8: 14 year old female presented with Adolescent Idiopathic Scoliosis from Robert Pashman

A 14 year old girl presented with 38 degree Adolescent Idiopathic Scoliosis. The curve progressed within a few months, and she required scoliosis surgery. Dr. Pashman performed a posterior spinal fusion.

      Case Review:

      Progressive Adolescent Idiopathic Scoliosis treated with a Posterior Spinal Fusion from T3 to L1

      Patient History:

      14-year-old post menarchal female
      Adolescent Idiopathic Scoliosis.
      X-rays taken from August 2006/ May 2007 show thoracic curve had progressed from 38 to 47 degrees.
      She has a 2.5 cm right rib hump, with significant right truncal shift. She has minimal left flank fullness which is noted, which is easily correctable on left side bending. She is well-balanced in a frontal and sagittal plane. She has slightly hyper reflexic lower extremities, but no evidence of neurologic deficits.
      Intermittent bouts of the neck, upper back, and low back pain.

      Pre-op X-rays:

      36 x 14 x-rays show that she has a 51° right thoracic and a 32° left lumbar curve, which is classified as 1BN curve. She has a slightly high accentuated thoracic kyphosis at this point.

      Indications for Surgery:

      Progressive adolescent idiopathic scoliosis, type 1B, 51° curve.
      Progressive deformity
      Failed conservative therapy.
      Upper and lower back pain.
      Cosmetic deformity
      Significant rotation.

      Surgical Strategy:

      1. Posterior instrumented fusion, thoracic 3 to lumbar 1 using pedicle screw rod construct, stainless steel
      2. Posterior spinal fusion, thoracic 3 to lumbar 1 using combination of locally harvested autogenous bone and morselized allograft
      3. Concave osteotomy, thoracic 6 to thoracic 11 for semi- ankylosed concave facet joints
      4. Intraoperative SSEPs
      5. Intraoperative fluoroscopy management
      6. Interoperative Pictures

      Post-Op Films:

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

      Pre-Op/Post-op Comparison:

      The patient is happy with the cosmetic outcome of her surgery. Her shoulders are even, and the rib hump was reduced.

      Pre-Op/Post-op Comparison:

      The patient is perfectly aligned, and very happy with her outcome. She resumed her normal sporting activities when the fusion healed.

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