The patient, a 19-year-old female, presented in 2001 with adolescent idiopathic scoliosis measuring 40 degrees. Her curvature progressively worsened over several years of monitoring, reaching 51 degrees by November 2006. Surgery was indicated due to the rigidity and progression of her double major thoracic curves, as well as significant pain. In January 2007, she underwent posterior spinal fusion and segmental instrumentation from T2 to L1, with concave osteotomies from T4 to T9. Post-operative x-rays showed her curvature was corrected from 51 to 10 degrees.

1. 51°
Case Review:
Adolescent Idiopathic
Scoliosis
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
The patient presented in April 2001 with Adolescent
Idiopathic Scoliosis, 40° curvature.
The patient has juvenile diabetes
The patient was followed from 2001 to 2006. In that
time, the curve progressed from 40° to 51°.
Significant thoracic pain
Rib hump and Cosmetic deformity

3. Curve Progression
In April 2001, the patient presented in with Idiopathic Scoliosis, with
a 40° curvature, insulin dependent diabetes
At 1 year check-up in March 2002 , patient had 41° curvature
In June 2003 - 2 cm right rib hump with significant rotation. 36x14
x-rays now reveal a 45° curve
At 6 month check-up in November 2003 – 45° curvature
In March 2005 – significant cosmetic deformity, curvature of 48°
In May 2006 – 48° curve
November 2006 – 51° curve, classified as a Lenke 2AN
40° 41° 45° 45° 48° 48° 51°
April 2001 March 2002 June 2003 Nov 2003 March 2005 May 2006 Nov 2006

4. 51°
45°
March 2005 May 2006

5. Bending Films
L L
The patient's left side bender shows that the proximal curve bent down to approximately
28° which constitutes double thoracic curves, specifically because the right shoulder is
depressed. I think that the instrumentation should be carried to approximately T2 or T3,
so that her shoulders will be level, and this was explained to her. The thoracic curve is
flexible to approximately 31°.

6. Rotation and Lordosis
Initiating Factor in Adolescent
Idiopathic Scoliosis

7. Indications for surgery
The patient is a 19-year-old female with progressive
adolescent idiopathic scoliosis. This is a double major
rigid curve, 51°. The proximal curve, which is 35°, bends
out to 28°, which constitutes a structural proximal
thoracic curve. This necessitated instrumentation up to
T2 or T3 to correct the proximal curve so that the
shoulders and pelvis could become balanced.
A 51°Lenke 2AN progressive, double thoracic scoliosis.
Rigid deformity, failed conservative therapy.
Significant thoracic pain secondary to scoliosis and
spinal deformity.
Rib hump.

8. Surgical Strategy
Segmental spinal instrumentation for correction of
thoracic scoliosis, T2 to L1 (eleven levels).
Posterior spinal fusion, T2 to L1.
Concave osteotomy at T4, T5, T6, T7, T8 and T9, for
correction of rigid thoracic scoliosis.
Local autogenous bone graft harvesting.
Intraoperative motor evoked potentials.
Intraoperative fluoroscopic control.

9. Post-Op X-Rays
She is very well balanced
in the frontal and sagittal
plane and has no
residual rib hump or
deformity.
January 2007

10. X-Ray comparison
Her 36x14 x- rays show her
curve to be corrected from
approximately 51° to 10°.
51° 10°
May 2006 January 2007