A 15 year old female with Progressive Adolescent Idiopathic Scoliosis. Dr. Pashman performed a Posterior Spinal Fusion T3-L3.

1. Case Review:
24°
15 year old female
41°
with progressive
Adolescent Idiopathic
Scoliosis, triple
51° curvature.
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• The patient presented at age 13, when scoliosis was detected
during routine school screening.
• Post-menarchal female
• Type 6 curve or primary thoracolumbar curve with significantly
rotated and structural thoracic component.
• She also has some asymmetry of her shoulders.
• The patient has a 1 cm leg length inequality
• Patient followed for two years prior to surgery.

3. Pre-op X-rays
The patient seems to be
decompensated slightly in the
24°
coronal plane. She has a
hyperthoracic kyphosis,
41° compensatory lumbar lordosis.
51°
She was significantly worked up
to verify that this is an
idiopathic curve, not a
congenital curve.

4. Bending X-rays
Right and left side bending show a horizontality of L3 on the
Harrington drop line specifically with bending

5. Indications for Surgery
1. Progressive adolescent idiopathic scoliosis type 6 curve T2 to T5
of 24°, T6 to T9 of 41°, and T10-L5 of 51° respectively.
2. Progressive deformity despite conservative therapy.
3. Intermittent upper and low back pain.

6. Surgical Strategy
• Thoracic 3 to lumbar 3 segmental spinal instrumentation using
pedicle screw rod construct, stainless steel, 1/4-inch.
• Posterior spinal fusion thoracic 3 to lumbar 3 using locally
harvested autogenous bone and allograft extender.
• Bilateral facetectomy and osteotomy for partially ankylosed spine
thoracic 4 to thoracic 10.
• Induction of flexibility with radical facetectomy thoracic 12 to
lumbar 2.
• Interlaminar decompression for visualization of pedicles, L1-2,
L2- 3 on the left.
• Intraoperative fluoroscopy.
• Intraoperative somatosensory evoked potentials and motor
evoked potentials.

7. Post-op Films
The hardware in excellent
position, and over 50%
correction of her curve was
8° obtained.
However, we can see that
21°
her head is shifted slightly to
the right and she has some
20° obliquity of her pelvis. We
have recommended a heel
lift to address the patient’s
leg length discrepancy.

8. Pre-Op/Post-op Comparison
24° 8°
41° 21°
51°
58° 20°