A 23 year old male presented with a triple adult idiopathic scoliosis curvature. The curvature progressed despite bracing. Dr. Pashman performed a spinal fusion from T4-L3.

1. 36° Case Review:
Triple Curvature Adult
58° Idiopathic Scoliosis, treated
with a posterior spinal
fusion, T4 to L3
44°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
23-year-old male
Progressive Adult/Adolescent Idiopathic Scoliosis
The curve progressed despite the patient’s compliance with
wearing the brace as a child.
The curves measured Cobb angle, thoracic-thoracic-lumbar,
at 36/58/44, and the 58-degree thoracic curve is rigid. This is
classified as a triple major curve by side bending or a 4C
curve.

3. Pre-op X-rays
Clinically, the patient had a right
rib hump and significant left
lumbar fullness, which indicated
structurality and significant
36° rotation of the lumbar component,
deeming this a triple major curve.
58° Although the shoulders are
somewhat level, the proximal
curve could be mobilized through
the proximal thoracic segments.
44° The patient has a cervical rib and
lumbosacral transitional vertebra,
and the count was adequately
matched with the intraoperative
observation of the curve angles.

4. Indications for Surgery
Type 6 triple major adult/idiopathic progressive scoliosis;
type 4C curve.
Rigid deformity with increasing pain in thoracic and lumbar
spine.
Sagittal and coronal plane decompensation with highly
rotated, rigid scoliosis.
Failure to be treated conservatively with adolescent bracing.

5. Surgical Strategy
1. Segmental spinal instrumentation, thoracic-4 to lumbar-3,
using Medtronic Legacy 5.5 stainless steel pedicle screw-rod
construct.
2. Posterior spinal fusion, T4 to L3, using locally harvested
autogenous bone and recombinant human bone
morphogenetic protein.
3. Mobilization of rigid thoracic and lumbar curve through
spinal osteotomies, T5 to T11 (these are Smith-Petersen
osteotomies), and mobilization with radical facetectomy and
osteotomy of lumbar spine, L1 to L3.
4. Interlaminar decompression for visualization of medial
pedicle, L3.
5. Intraoperative somatosensory evoked potential and motor
evoked potential management.
6. Intraoperative fluoroscopy management.

6. Post-Op Films
20°
A 38° correction was obtained. The
patient is well balanced in both the
sagittal and coronal planes.

7. Pre-Op/Post-op Comparison
36°
58° 20°
The patient had an excellent
44° outcome. His shoulders and hips
are level, his rib hump decreased.
From a clinical standpoint, he is
well balanced in both the frontal
and sagittal planes.

8. Pre-Op/Post-op Comparison