Dr. Pashman followed the patient for three years. After a growth spurt, her scoliosis curvature progressed significantly, and she required scoliosis surgery.

1. Case Review:
15 year old female
with progressive
61°
Adolescent Idiopathic Scoliosis
55°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 15-year-old female
• Progressive Adolescent Idiopathic Scoliosis
• The patient was followed for 3 years
• The patient had a recent growth spurt
• The patient has a significant rib hump

3. Pre-op X-rays
54° 60°
27°
37°
34°
2009 2010

4. Bending X-rays
• 61-degree right thoracic, 55-degree
left lumbar curve and can be
described as a Lenke 1C versus 3
curve, most likely a 1C curve
because right and left side bending
show the lumbar compensatory
component does reduce less than
25, although the curve magnitude
ratio is 1.2 and rotation radius ratio
is 1.0. moreover, the deviation
from midline is almost parity and
therefore there was a significant
amount of thought put into what
fusion levels should be done

5. Indications for Surgery
1. Lenke 1C versus 3, 61-degree right thoracic, 55-degree left
lumbar progressive adolescent idiopathic scoliosis.
2. Significant cosmetic deformity with 3-cm right rib hump and
left flank fullness.
3. Progressive deformity failed conservative therapy in a post
menarchal adolescent.

6. Surgical Strategy
• Thoracic 3 to lumbar 3 segmental spinal instrumentation using 5.5
stainless steel rod screw construct.
• Posterior spinal fusion thoracic 3 to lumbar 3 using locally harvested
autogenous bone with autograft plus rib graft. .
• Multiple level Smith-Petersen osteotomy for induction of a flexibility and
cosmetic result.
• Smith-Petersen osteotomy for induction of flexibility thoracic 6 to
lumbar 1, bilateral facetectomy and midline takedown.
• Intraoperative O-arm neuro navigation.
• Intraoperative motor evoked potential interpretation and
• Right chest wall removal thoracoplasty with 6 ribs removed using
autogenous bone graft for reduction of rib hump and induction of
flexibility.

7. Post-op Films

8. Pre-Op/Post-op Comparison