A 20 year old female from Mexico presented with 58 degree lumbar scoliosis. She was diagnosed at age 14, and was not prescribed a TLSO brace. Dr. Pashman performed a posterior spinal fusion on the patient.

1. Case Review:
20 year old female with
Adult Idiopathic Scoliosis,
58° lumbar curvature,
traveled from Mexico for
58°
surgical treatment.
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• A 20-year-old female
• Diagnosed with Adolescent Idiopathic Scoliosis at age 14
• Traveled from Mexico for treatment.
• No bracing as a child/teenager
• 2 cm right rib flank fullness
• Intermittent back pain
• Tried conservative treatment including: traction, acupuncture,
and chiropractic.

3. Pre-op X-rays
There is a sharp angular 58°
lumbar curve apex at L2-3 to
the right. The patient is
decompensated approximately
1-2 cm to the right. The patient
has a significant rotation
angulation at L3-4.
58°

4. Bending X-rays
The patient's left side
bending corrects to 8°, but
still off midline. Right
bending goes down to 38°.
Right and left side bending
films reveal moderate
flexibility of the lumbar
curve but increased
correction on left side
bending of L4 to S1.

5. Indications for Surgery
1. Kim/SRP type 1, King type 5 lumbar adult idiopathic scoliosis
58 degrees.
2. Thoracolumbar kyphosis due to #1.
3. Low back pain.
4. Failed conservative therapy.

6. Surgical Strategy
• Segmental spinal instrumentation T11 to L4 using 1/4-inch
stainless steel pedicle screw rod construct.
• Posterior spinal fusion T11 to L4 using combination of
autogenous allo and RH BMP bone T11 to L4.
• Multiple level Smith-Petersen osteotomy for induction of
flexibility of thoracolumbar kyphosis and stiff lumbar curve.
• Intraoperative O-Arm neuronavigation management.

7. Post-op Films
The patient is well balanced in
the sagittal and coronal planes.
Her curve was reduced from
58° to 22°.
The patient returned to Mexico
approximately 2 weeks
22°
following surgery, and then sent
post-operative x-rays for review.

8. Pre-Op/Post-op Comparison
22°
58°