A 14 year old female presented for a second opinion on her Adolescent Idiopathic Scoliosis treatment. The patient wore a brace and Dr. Pashman observed the curve for two years before recommending surgery.
Case Review #14: 16 year old female with progressive adolescent scoliosis
Case Review:16 year old female withProgressive AdolescentIdiopathic ScoliosisRobert S Pashman, MDScoliosis and Spinal Deformity Surgerywww.eSpine.com
Patient History14 year old female presented with progressive AdolescentIdiopathic Scoliosis. Her curve was thought to have increased20° over the duration of her treatment.The patient wore a brace.When she presented at my office, her curve was 40°.Curve progressed to 46° two years from initial consultation.The patient has 2-cm right rib hump, minimal left lumbarfullness and what appears to be a gross thoracic shift to the right.
Pre-op X-rays46° 46° 1AN curve with apex at T10, which is fully flexible. The patient has a significant right rib hump.
Indications for Surgery1. Progressive adolescent idiopathic scoliosis, 1AN, 46 degree, right thoracic curve.2. Significant pain, thoracic and lumbar spine.3. Cosmetic deformity of thoracic spine.4. Failed conservative therapy.
Surgical StrategySegmental spinal instrumentation, T2 to L1 using 5.5 stainlesssteel pedicle screw rod construct.Multiple level osteotomies, T5 to T10, including Smith-Petersonosteotomies for induction of flexibility for improvement ofadolescent idiopathic scoliosis.Posterior spinal fusion, T3 to L1, using locally harvestedautogenic bone and allograft.Removal of fractured facet under loupe magnification, T7 on theleft.Plastic closure of the wound.Intraoperative SSEP management.Intraoperative fluoroscopy management.
Post-Op Films The patient is well balanced in the coronal and sagittal planes.