20 year old female with a 48° primary thoracolumbar curve with a compensatory 34° thoracic curve. Dr. Pashman treated the patient with a thoracolumbar anterior spinal fusion.

1. Case Review:
Adolescent/Adult
34° Idiopathic Scoliosis
Thoracolumbar curve
treated with an anterior
48° spinal fusion
Robert S. Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
– 20-year-old female,
– Progressive adolescent idiopathic scoliosis, now adult
idiopathic scoliosis.
– 47º thoracolumbar curve with thoracic compensatory
component.
– The patient bends out to 17 º and a thoracic curve from
34 º has pretty much a straight bend to the left but has
a somewhat fixed lumbosacral fractional curve which is
problematic causing approximately 2-3 cm
decompensation to the left.
– No rotation of the thoracic spine and therefore the
primary thoracolumbar component will be fused.

3. Indications for Surgery
1. Adolescent/Adult
idiopathic scoliosis
2. Progressive, 48º
primary
34° thoracolumbar curve
with compensatory
34º thoracic curve.
3. Failed conservative
48°
therapy.
4. Low back pain and
cosmetic deformity.

4. Bending x-rays
L R
Bending x-rays are taken to reveal how flexible the curve is and can give some
prediction of the amount of correction that can be obtained with surgery.

5. Surgical procedure
1. Left T11 thoracotomy, thoracoabdominal retroperitoneal
approach to the thoracolumbar spine.
2. Complete diskectomy T11-12, T12-L1, L1-L2 and L2-L3.
3. Anterior interbody fusion, posterior anterior spinal fusion
T11-12, T12-L1, L1-L2, L2- L3.
4. Segmental spinal instrumentation with transvertebral screw
staple rod construct T11-L3 for adolescent idiopathic
scoliosis.

6. X-ray comparison
A 31º correction
(52%) was
obtained. Note the
excellent coronal
60° sagittal balance.
29°
40°
22°

7. Lateral
x-ray
comparison
Note the maintenance of
sagittal balance.