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Case Review #23: 15 year old male with Adolescent Idiopathic ScoliosisScoliosis


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A very active 15 year old male presented with progressive Adolescent Idiopathic Scoliosis. His curve progressed after a recent growth spurt. The patient had scoliosis surgery, and returned to ROTC.

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Case Review #23: 15 year old male with Adolescent Idiopathic ScoliosisScoliosis

  1. 1. Case Review: 15 year old male with55° progressive Adolescent Idiopathic Scoliosis 54° Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery
  2. 2. Patient History• 15 +7-year-old Risser 4 male• Progressive Adolescent Idiopathic Scoliosis• Very active student, ROTC participation• Recent growth spurt• No other contributing medical conditions.
  3. 3. Pre-op X-rays The patient is a Risser 4.55° The characteristics of the curve 54° are a rigid 55° right thoracic, a significantly rotated 54° lumbar curve with a significant thoracolumbar kyphosis measuring 30°.
  4. 4. Bending Films • On the right-sided lumbar side bending the patient displays neutrality as the midline bisects Harrington neutral vertebral rotation between the L3-4 disk. The thoracic right side- bending is structural to about 36 degrees. • Left side- bending shows a significant flexibility of the lumbar component which reduces to approximately 20 degrees the apex L2-3 is still rotated and does not neutralize until the L3-4 disk.
  5. 5. Indications for Surgery1. Lenke 1C versus 3, 51 degree right thoracic, 48 degree left lumbar curve progressive adolescent idiopathic scoliosis.2. A 3 cm right rib hump left flank fullness.3. Progressive deformity with failed conservative therapy in a adolescent.
  6. 6. Surgical Strategy• Thoracic 3 to lumbar 3 segmental spinal instrumentation using ¼ inch stainless steel rod screw construct.• Posterior spinal fusion thoracic 3 to lumbar 3 using locally harvested autogenous bone with allograft extender.• Multiple level Smith-Petersen osteotomy for induction of flexibility and cosmetic result.• Thoracic 6 to lumbar 1 bilateral facetectomy and midline takedown.• Intraoperative OR neuro navigation.• Intraoperative motor evoked potential interpretation.• Intraoperative plastic closure.
  7. 7. Post-op Films • The patient did very well post-operatively, and returned to school after a couple of weeks.
  8. 8. Pre-Op/Post-op Comparison51° 48°