Case Review #32: 21 year old male with Adult Idiopathic Scoliosis

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21 year old male presented with Adult Idiopathic Scoliosis which progressed despite bracing. Dr. Pashman treated the patient with a posterior spinal fusion from T2-L1. Scoliosis curve was a KIM/SRP Classification 1.

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Case Review #32: 21 year old male with Adult Idiopathic Scoliosis

  1. 1. Case Review: 21 year old male, with Adult60° Idiopathic Scoliosis which progressed despite bracing. 42° Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
  2. 2. Patient History21-year-old maleAdolescent Idiopathic ScoliosisWas braced as a child.Noticed decreased height.No other medical problems.Right rib hump, moderate left lumbar fullness, balanced frontalsagittal plane. Motor sensory examinations intact.
  3. 3. Pre-op X-rays 36 x 14 x-rays show a type A/BN curve moderate rotation lumbar spine, 60° curve with 42° lumbar compensatory curve.60° The patient has a short right thoracic curve. This will be studied with CT scan to rule out 42° a congenital abnormality, but the patient would benefit from a selective thoracic fusion.
  4. 4. Bending X-rays On side bending, the patients lumbar spine to the left centers over, on right side bending, T12 comes to the mid- Harrington or mid- gluteal line, but clearly the curve is well left of the mid point. On right side bending, the lumbar curve is significantly flexible from 42° to 27° with significant derotation. The proximal thoracic curve is ridged at 35°, making this a double thoracic curve.
  5. 5. Indications for Surgery1. 2CN progressive adult idiopathic scoliosis.2. Upper thoracic pain.3. Thoracic kyphosis.4. Rigid curved failed conservative therapy.
  6. 6. Surgical StrategyThe patient has a rigid 60° primary thoracic curve and this willneed release. That is why multiple levels osteotomies were done.The plan is T2 to lumbar 1 because the lumbar spine was leftfree for auto balance.Segmental spinal instrumentation using a 5.5 stainless pediclescrew, rod construct, thoracic 2 to lumbar 1.Segmental osteotomy for release of rigid thoracic spine, 60°, T4,T5, T6, T7, T8, T9 and T10.Posterior spinal fusion, thoracic 2 to lumbar 1, using locallyharvested autogenous bone and croutons.Intraoperative SSEPs.Intraoperative fluoro.
  7. 7. Post-Op Films The patient is well balanced in the sagittal and coronal planes. He was very happy with his outcome. The patient returned to weight lifting and his job in the construction industry one year post-op.
  8. 8. Pre-Op/Post-op Comparison60° 42°

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