Case Review: Progressive Adolescent53° Idiopathic Scoliosis Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
Patient History22-year-old femaleProgressive Adolescent Idiopathic ScoliosisPatient presented with a 53° thoracic curveThe patient has anatomic numbering anomaly including 11 rib-bearingvertebrae and 6 lumbar vertebrae. On sagittal x-ray the patient hassignificant lumbosacral kyphosis indicative of a forme fruste disk andvestigial disk. The apex of the curve variably counted around T11-12, T12-L1, depending on how the count would go - looks like on x-ray to be athoracolumbar curve with a compensatory proximal left-sided thoraciccurve.The patients right shoulder is slightly depressed, but the upper curve bendsout to the left from approximately 30 to 22 degrees, and therefore becauseof its flexibility and significant unrotated state will be called a compensatorycurve. The patient could be classified as Lenke II if confirmed structurality ofthe proximal curve and/or a thoracolumbar with a proximal structural curve.
Pre-op X-rays The patient was diagnosed with Adolescent Idiopathic Scoliosis at 14 years old. She was treated with conservative53° management which incuded: pilates, physical therapy, and chiropractic care.
Bending X-raysRight and left side-benders show the L1 vertebrae levels to the left of the Harrington midcarpal line and therefore right and left side- bending also shows that the T8-9 disk opens completely and therefore the levels of T9 to L1 will be chosen.
Indications for SurgeryProgressive 50° right thoracolumbar Adolescent Idiopathic Scoliosis.Thoracic lumbar pain, secondary to progressive Adolescent Idiopathicscoliosis.Failed conservative therapy.Severe cosmetic deformity.
Surgical StrategyAnterior thoracoabdominal and short-segment anterior transvertebralfixation to attack the low thoracolumbar apex curve and to maintain flexibilityof the proximal curve as well as the distal curve, which is compromised atthis time because of the structural anomaly of the lumbosacral spine.T9 right thoracotomy, thoracoabdominal approach to the thoracolumbarspine.Removal, rib for rib graft harvesting.Radical diskectomy with spinal canal decompression, T9-10, T10-11, T11-12 and T12-L1.Segmental spinal instrumentation, T9 to L1, with transvertebral pediclescrew-rod construct, double-staple system Legacy stainless steel 5.5.Anterior interbody fusion, T9, T10-11, T11-12, T12-L1 with recombinanthuman bone morphogenic protein and autogenous bone- harvested bonestructural graft device.Intraoperative motor evoked potential interpretation.Intraoperative fluoroscopy and interpretation.
Post-Op Films Her thoracotomy is well-healed. The patient is not taking any pain medicine. Her balance is excellent. X-rays look good. No evidence of hardware failure. The patient is happy with her outcome.
Pre-Op/Post-op Comparison Her 53° curvature now has 24°53° been reduced down to 24° and she is doing well.
Pre-Op/Post-op Comparison The patient’s spine is balanced. The fusion is still growing, and will be complete at 12 months post-op.