Case Review #23: 15 year old male with Adolescent Idiopathic ScoliosisScoliosis
Case Review: 15 year old male with55° progressive Adolescent Idiopathic Scoliosis 54° Robert S Pashman, MD Scoliosis and Spinal Deformity Surgery www.eSpine.com
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.
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°.
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.
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.
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.
Post-op Films • The patient did very well post-operatively, and returned to school after a couple of weeks.