A 16 year old male, with a highly rotated thoracolumbar Adolescent Idiopathic Scoliosis. Dr. Pashman performed a Posterior Spinal Fusion T10-L3.

1. Case Review:
16 year old male with
Adolescent Idiopathic
58°
Scoliosis and a highly
rotated thoracolumbar
69° curve.
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 16½ year old male.
• Presented with a 42° right T4-T11, 58° left T11-L3 with a
thoracolumbar kyphosis.
• At six month follow-up appointment, the cures had progressed
to 58° T4-T11 right, 69° left T11-L3
• This is a progressive type 6C C curve which shows an increasing
highly rotated thoracolumbar curve to the left with a
compensatory right thoracic curve.
• The patient reports minimal pain.
• He is an avid tennis player.

3. Pre-op X-rays
• The patient has a hint of
thoracolumbar kyphosis which
is probably due to progressive
rotation, as the coronal plane
rotated into the saggital
component.
58°
• The patient is decompensated
approximately 2cm to the left
69° of plum line.
• The patient has slight
depression of his left shoulder.

4. Bending X-rays
The bending films
show L3-S1 strained
significantly on right-
side bending and the
proximal thoracic
curve bends to 10
degrees on right-side
bending. The lumbar
curve bends out at
20° on left side
bending.

5. Indications for Surgery
1. Progressive adolescent idiopathic scoliosis, type 5C/6C, 58° left
thoracolumbar curve.
2. Progressive deformity with right rib and left flank fullness.
3. Increasing low back pain with increasing deformity and rotation.
4. Failed conservative therapy.

6. Surgical Strategy
• Segmental spinal instrumentation T10-L3 using 5.5 stainless steel
pedicle screw rod construct.
• Posterior spinal fusion T10-L3 using locally harvested
autogenous bone and RH BMP.
• Multiple level osteotomy for increase of flexibility T12-L2 with
bilateral takedown of facet joints.
• Neuronavagation with placement of percutaneous pin reference
framing, left iliac crest.
• Intraoperative SSEPs.

7. Post-op Films
• The patient is well
balanced in both the
frontal and sagittal planes.
He plum lines with his
head directly over his
hips.
• His rib hump was reduced
with surgery.

8. Pre-Op/Post-op Comparison
28°
58°
69°
25°