A 17 year old female with Progressive Adolescent Idiopathic Scoliosis. Dr. Pashman performed a Posterior Spinal Fusion T4-L4.

1. Case Review:
17 year old female with
progressive Adolescent
57°
Idiopathic Scoliosis,
followed for six years prior
58° 52° to surgery.
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 18 year old female
• Followed by Dr. Pashman for 5+ years.
• Progressive Adolescent Idiopathic Scoliosis
• Upper back pain
• Lumbar back pain
• Failed conservative therapy

3. Pre-op X-rays
Note the progression
of the curve on these
interval x-rays. The
size and rotation of
both curves suggest
44° 57°
this is a double
major curve, not a
43° thoracic deformity
52°
with a compensatory
lumbar curve.
June, 2008 Feb, 2010

4. Bending X-rays
Bending films suggest both thoracic and lumbar structurality indicating that this
is a double major curve. Right-side bending revealed that L4 could be centered
over the central ala and therefore this was chosen as the distal fusion level.

5. Indications for Surgery
1. Progressive right thoracic Kim SRP2/type 1CN curved
adolescent idiopathic scoliosis.
2. Double major curve with severe rotation thoracic and lumbar
component.
3. Failed conservative therapy with progressive curve, follow time
6 years.
4. Increasing pain upper thoracic low back pain due to progressive
scoliosis.
5. Element of thoracic kyphosis, adolescent idiopathic scoliosis.

6. Surgical Strategy
• Thoracic 4 to lumbar 4 segmental spinal instrumentation with
5.5 stainless steel pedicle screw/rod construct.
• Posterior spinal fusion, thoracic 4 to lumbar 4, with combination
of locally harvested autogenous bone crouton extenders and
rhBMP.
• Multiple level Smith-Petersen osteotomy for duction of flexibility
to rigid thoracic component, T5 to T11, that is a 6-level
osteotomy.
• Intraoperative OR neuro-navigation.
• Intraoperative somatosensory evoked potential and motor
evoked potential interpretation.
• Plastic closure of the wound.

7. Post-op Films
• The patient is well balanced in
the sagittal and coronal planes.
• A 39° thoracic correction was
obtained.
18°
• A 52° lumbar correction was
obtained.
10°
0°

8. Pre-Op/Post-op Comparison
57° 18°
52°
58° 10° 0°