A 16 year old female with Adolescent Idiopathic Scoliosis. Her curve progressed to 50° despite bracing. Dr. Pashman treated her with an Anterior Interbody fusion from T11 to L3.

1. Case Review:
Adolescent Idiopathic
Scoliosis in a
16 year old female.
50°
Robert S Pashman, MD
Scoliosis and Spinal Deformity
www.eSpine.com

2. Patient History
16-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.

3. Pre-op X-rays
The 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 lumbosacral
obliquity but this is no doubt due to
the thoracolumbar curve and the rest
of the frontal and sagittal plane
50°
deformity is well balanced. She has
no sagittal plane deformity.

4. L L
Bending
X-Rays
Right/left bending
indicated that the T11 to
L3 anterior transvertebral
fixation would be best to
conserve levels, the
proximal curve being in
L L 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.

5. Indications for Surgery
Adolescent 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

6. Surgical Strategy
Segmental 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.

7. Post-Op X-rays
No pain. Balance is excellent.
Curve has been reduced almost 60%.
Her balance is excellent.
She is very pleased with her outcome.

8. X-ray comparison
50°
20°