Robert S Pashman, MDRobert S Pashman, MDScoliosis and Spinal DeformityScoliosis and Spinal Deformity

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Case Review: Case Review:

Adolescent Idiopathic Adolescent Idiopathic Scoliosis in a Scoliosis in a

16 year old female.16 year old female.50°

Patient HistoryPatient History16-year-old female

Followed for scoliosis for quite some time.

Curve progressed despite wearing a brace.

Progressive spinal deformity and significant thoracolumbar pain.

She reports neck, back pain with radiation intermittently to the left arm, bilateral upper extremity numbness, tingling in spinal area, low back and left arm although this is not constant. She has no other non-idiopathic concordant signs for scoliosis.

Shoulders and hips are level. She is slightly decompensated in the coronal plane but well-balanced in the sagittal plane.

Significant left-sided elevation of her flank and slight right rib hump.

PrePre--op Xop X--raysraysThe 36X14 x-rays show that she has a 50° left lumbar curve with apex in the proximal lumbar spine with significant rotation and a compensatory thoracic curve.

She has significant lumbosacralobliquity but this is no doubt due to the thoracolumbar curve and the rest of the frontal and sagittal plane deformity is well balanced. She has no sagittal plane deformity.

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Bending Bending XX--RaysRays

LL

LL

Right/left bending indicated that the T11 to L3 anterior transvertebralfixation would be best to conserve levels, the proximal curve being in excess of 40°, bent down to 33° and is not rotated indicating true compensatory curve.

The patient is well-balanced over the sacral ala with plumb and straight line. At this point, the patient's balance will be taken into consideration.

Indications for SurgeryIndications for SurgeryAdolescent idiopathic scoliosis.

Thoracolumbar 50° scoliosis with compensatory curve in the thoracolumbar spine.

Failed conservative therapy

Curvature progression

Status post conservative treatment; bracing with failure to stop curve progression.

Low back pain

Surgical StrategySurgical StrategySegmental spinal instrumentation thoracic 11 to lumbar 3-5 level using transvertebral Legacy screw, rod and staple construct. Anterior interbody fusion with PEEK device with autogenous bone graft, L1-2 and L2-3. Radical diskectomy with spinal canal decompression T11-12 to L2-3-4 level. Anterior interbody fusion with autogenous rib graft T11 to L3. This is 4 levels. Harvest autogenous rib graft. Thoracoabdominal approach T11 on the left. Motor evoked potentials. Plastic closure. Anterior vertebrectomy, subtotal L1 and T12 for harvesting autogenous bone graft.

PostPost--Op XOp X--raysraysNo pain. Balance is excellent.

Curve has been reduced almost 60%. Her balance is excellent.

She is very pleased with her outcome.

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XX--ray comparisonray comparison

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