Case Review:

20 year old female with Adolescent Idiopathic Scoliosis, 58° curvature.

Robert S Pashman, MDScoliosis and Spinal Deformity Surgerywww.eSpine.com

58°

Patient History

• The patient was diagnosed with scoliosis at age 16 with a curvature measuring 40°

• Her curvature continued to progress to 50°, and the patient opted to wait until after she graduated from college to proceed with surgery.

• The patient is a top level swimmer and water polo player, and very athletic in general.

• At the time of surgery, she was classified with a Type 2 curve that is 58° right thoracic with a structural upper thoracic curve measuring in excess of 45° with depression of the right shoulder.

Pre-op X-rays

58°

Bending X-raysThe patient has flexibility of the lumbar compensatory curve and on right and left side bending compensates well through the L- 1 vertebra. The apex is at T11-10 and the patient has a 2 cm rib hump and was preoped for a thoracoplastypending cosmetic results.

Indications for Surgery1. Kim/SRP type 1 type 2 adolescent/adult scoliosis, progressive,

58° thoracic curve. 2. Structural proximal thoracic curve 3. Documented progression with depression right shoulder. 4. Increasing upper and low back pain.

Surgical Strategy• Segmental spinal instrumentation thoracic 3 to lumbar 1 using a

5.5 stainless steel pedicle screw rod construct. • Posterior spinal fusion, thoracic 3 to lumbar 1 using locally

harvested autogenous bone, allograft putty and RH BMP. • Multiple level segmental osteotomy for fractional curve flexibility

induction. • Smith-Peterson osteotomy, T4-5, T5-6, T6-7, T7-8, T8-9, T10-11

and T11-12. • Intraoperative O-arm neuronavigation. • Plastic closure of wound.

Post-op Films• A 48° correction was

obtained• The patient is well

balanced in both the frontal and the sagittalplanes.

• She is very happy with the outcome of her surgery.10°

Pre-Op/Post-op Comparison

58° 10°