A 22-year-old female with adolescent idiopathic scoliosis and a 61° curvature underwent a posterior spinal fusion, resulting in a reduction of the curve to approximately 22°. The surgery involved several techniques, including facet osteotomies and spinal instrumentation, and the patient reported improvement in symptoms and satisfaction with her cosmetic outcome. Post-operative x-rays showed excellent truncal balance and proper positioning of the instrumentation.

1. Case Review:
Adolescent Idiopathic Scoliosis
61° Curvature, Treated with a
61°
Posterior Spinal Fusion
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
22-year-old female
Adolescent Idiopathic Scoliosis
61° Braced as a child, stayed at 36º curvature
Followed up intermittently
Presented with a 61º Lenke 1AN curve, with
Cobb from T3 to T11.
The patient has increasing rib hump. Her height
is decreasing. She has pain over the thoracic
spine.
She has significant thoracic shift to the right. The
left shoulder is down. There is significant rotation
of the thoracic spine and deformity.

3. Pre-op X-rays
The lateral x-ray shows she has
lumbosacral transitional
vertebra and hyperlordosis of
the fractional lumbosacral joint,
61° but she has hypokyphosis of
the thoracic spine.

4. Bending Films
On left side bending, the
patient's proximal curve from
T1 to T4 bends out to 40°.
This is a non-structural
curve. The main thoracic
curve bent out to 40° and is
somewhat rigid. Left side
bending shows that the
whole lumbar complex
deviates to the left of the
midline and his highly
flexible. The neutrally rotated
vertebra is L1.

5. Surgical Strategy
Multiple facet osteotomies for mobilization of
spine T3 down to L1.
Micro-decompression T4-5 on the right.
Bilateral laminectomy T4-5, for fractured facet
joint status
Segmental spinal instrumentation thoracic 2
down to lumbar 1 - 11 level posterior
Instrument fusion using CD Legacy stainless
steel 55 pedicle screw rod construct.
Posterior spinal fusion thoracic 2 to lumbar 1
using combination of locally harvested
autogenous bone, RHBMP and allograft putty.

6. Post-Op Films
Truncal Balance is excellent.
She is well balanced in the
frontal and sagittal planes.
The instrumentation looks
like it’s in good position.
The patient is happy with her
cosmetic outcome, and
reports a reduction in her
symptoms.

7. X-Ray Comparison
The curve has been
reduced 36%, from 61° to
approximately 22°.
61° 22°

8. X-ray Comparison