A 28-year-old female with progressive idiopathic scoliosis presented with a 58° thoracolumbar curve, originally scheduled for surgery in 2000. The patient underwent a complex surgical procedure including spinal instrumentation and fusion, along with osteotomies for improved flexibility. Post-operative results show a well-balanced spine, with the patient expressing satisfaction with the surgical outcome.

1. Case Review:
28 year old female with progressive
Adult Idiopathic Scoliosis
58°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 28-year-old female
• The patient has been waiting to have surgery for quite some
time. She was originally scheduled in 2000, at age 17.
• The curve is progressive. In 2006 it was a 50-degree
thoracolumbar curve and in June 2010, it was 58 degrees.
• She also has some structurality to the upper thoracic curve as
evidenced by depression of her right shoulder.

3. Pre-op X-rays
• 58° right highly rotated,
progressive thoracolumbar
curve.
• Kim/SRP type 1 curve
58°

4. Bending X-rays
On right and left side
bending thoracolumbar
curve is highly flexible, but
the structural left upper
curve is not. Therefore the
strategy is at T2-L3 to
induce balance because on
left side bending L3
horizontalizes over the mid
sacrum.

5. Indications for Surgery
1. 58 degree right thoracolumbar curve.
2. Structural left high thoracic curve.
3. Progression of adult idiopathic scoliosis.
4. Thoracic and low back pain.
5. Failed conservative therapy.

6. Surgical Strategy
• Segmental spinal instrumentation thoracic to lumbar.
• Using the quarter inch stainless steel rod screw construct.
• Posterior spinal fusion T2 to L3 using locally harvested
autogenous bone, allograft croutons and RhBMP.
• Multiple level Smith-Petersen osteotomy for induction of
flexibility T3-4, T4-5 to T12-L1 that is a 7 level osteotomy.
• Intraoperative O-arm neuro navigation
• Intraoperative motor evoked potential interpretation.

7. Post-op Films
The patient is well balanced
in the coronal and sagittal
plane. She is very happy
with the outcome of her
surgery.

8. Pre-Op/Post-op Comparison
58°