A 22 year old female presented with a progressive 53° thoracic curve. She was treated with an Anterior Interbody fusion T9-L1.

1. Case Review:
Progressive Adolescent
53° Idiopathic Scoliosis
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
22-year-old female
Progressive Adolescent Idiopathic Scoliosis
Patient presented with a 53° thoracic curve
The patient has anatomic numbering anomaly including 11 rib-bearing
vertebrae and 6 lumbar vertebrae. On sagittal x-ray the patient has
significant lumbosacral kyphosis indicative of a forme fruste disk and
vestigial 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 a
thoracolumbar curve with a compensatory proximal left-sided thoracic
curve.
The patient's right shoulder is slightly depressed, but the upper curve bends
out to the left from approximately 30 to 22 degrees, and therefore because
of its flexibility and significant unrotated state will be called a compensatory
curve. The patient could be classified as Lenke II if confirmed structurality of
the proximal curve and/or a thoracolumbar with a proximal structural curve.

3. Pre-op X-rays
The patient was diagnosed
with Adolescent Idiopathic
Scoliosis at 14 years old. She
was treated with conservative
53° management which incuded:
pilates, physical therapy, and
chiropractic care.

4. Bending X-rays
Right 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.

5. Indications for Surgery
Progressive 50° right thoracolumbar Adolescent Idiopathic Scoliosis.
Thoracic lumbar pain, secondary to progressive Adolescent Idiopathic
scoliosis.
Failed conservative therapy.
Severe cosmetic deformity.

6. Surgical Strategy
Anterior thoracoabdominal and short-segment anterior transvertebral
fixation to attack the low thoracolumbar apex curve and to maintain flexibility
of the proximal curve as well as the distal curve, which is compromised at
this time because of the structural anomaly of the lumbosacral spine.
T9 right thoracotomy, thoracoabdominal approach to the thoracolumbar
spine.
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 pedicle
screw-rod construct, double-staple system Legacy stainless steel 5.5.
Anterior interbody fusion, T9, T10-11, T11-12, T12-L1 with recombinant
human bone morphogenic protein and autogenous bone- harvested bone
structural graft device.
Intraoperative motor evoked potential interpretation.
Intraoperative fluoroscopy and interpretation.

7. 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.

8. Pre-Op/Post-op Comparison
Her 53° curvature now has
24°
53° been reduced down to 24°
and she is doing well.

9. 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.