Adolescent Idiopathic Scoliosis Case G

Case Review #G: 15 year old male with Adolescent Scoliosis from Robert Pashman

A 15 year old male with Adolescent Idiopathic Scoliosis and aspirations to become a professional golfer presented for treatment. After careful consideration, a surgical plan was devised to maximize his ability to pursue golf professionally.

  1. Case Review: 15 year old Male with Adolescent Idiopathic Scoliosis with aspirations58° to become a professional golfer. Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery
  2. Patient History15-year-old maleDiagnosed 4 years ago with Adolescent Idiopathic Scoliosis, whichwas approximately a 23° thoracolumbar curve at the timeStatus post a significant growth spurtPatient is a competitive golfer, index 9.7-10.0, playing JV at school
  3. Pre-op X-rays Progressive 58° thoracolumbar curve The shoulders are level. He has significant left thoracolumbar fullness, slightly elevated right scapula, and with whole truncal shift to the left,58° but well-balanced in the coronal and sagittal planes. The patient is neurologically intact.
  4. Bending X-raysL R This is a curve with a thoracic component which is mildly structural on right side bending but to less than approximately 30°. The patient has complete non-structurality of the compensatory subcurve lumbar component with almost complete horizontalization and neutralization with right and left- side bending. The Cobb angle approximately T9 to 11 will be used and the strategy will be an anterior spinal fusion.
  5. Indications for SurgeryThoracolumbar progressive Adolescent Idiopathic Scoliosis curvemeasuring 58°.Compensatory thoracic and lumbar component curves withprogression.Thoracic low back pain due to progressive scoliosis and rotation.Failed conservative therapy.
  6. Surgical Strategy – OptionsThe patient has expressed a deep desire to continue with competitivegolfing.A posterior spinal fusion would have to go approximately from T4 toL1 or L2 and by nature of the procedure, would displace the posteriorrectus spheni muscles and paraspinous muscles as well as disruptthe insertion of all the rhomboid, traps and shoulder girdle muscleswould necessarily doom him to a noncompetitive golf-playing career.Therefore, the patient in my estimation would be best served with ananterior thoracoabdominal from T9-L1. This would minimize thefusion levels and might prolong his golf career.
  7. Surgical Strategy1. T10 left thoracotomy and thoracolumbar retroperitoneal approach to the thoracolumbar spine.2. Radical discectomy with epidural decompression T9-10, T10-11, T12- L1.3. Interbody fusion with PEEK 8×10 mm device with Rh BMP T12-T11.4. Interbody fusion using morselized autogenous rib graft and Rh BMP T9- T10, T10-11 and T11-12.5. Segmental spinal instrumentation with laterally based trans vertebral pedicle screw construct using Legacy 6.5 quarter-inch screw staple instrumentation, T9 to L1.6. Placement of chest tube.7. Intraoperative SSEP motor evoke potential management.8. Intraoperative fluoroscopic management.
  8. Post-Op Films The patient did very well post- operatively. He is looking forward to returning to his golf game.
  9. Pre-Op/Post-op Comparison An excellent correction was obtained, while minimizing the number of levels fused. The patient is well balanced in the saggital plane.
  10. Pre-Op/Post-op Comparison The patient is well balanced in the coronal plane, and is very happy with his outcome.