A 21 year old female presented to Dr. Pashman with Progressive Adolescent Idiopathic Scoliosis. The patient had been followed for scoliosis, and was compliant wearing her brace. Her spinal curvature progressed despite physical therapy and bracing. Dr. Pashman treated her with a Posterior Spinal Fusion T3-L1.

1. Case Review:
21 year old female with
Progressive Adolescent
54° Idiopathic Scoliosis
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 21 year old female
• Followed for Adolescent Idiopathic Scoliosis
• She has noticed that the curve has gotten bigger, and that she has
lost height
• Intermittent low back pain

3. Pre-op X-rays
The patient has depression of her
left shoulder, approximately 5
degrees.
The patient has global truncal
54° shift 2 cm. She has a right thoracic
curve that measures 54 degrees, a
compensatory left lumbar curve
that measures 27.5 degrees of
proximal thoracic curve that
measures 31 degrees.

4. Bending X-rays
The left- sided bending
films shows that the L1
vertebra and T12
vertebrae go all way up to
neutrality. On left-sided
bending the right thoracic
curve is flexible to
approximately 38 degrees.

5. Indications for Surgery
1.Adult idiopathic scoliosis.
2.Progressive adult/adolescent idiopathic scoliosis Lenke type 1A,
3.Failed conservative therapy including bracing.
4.Now with progressive deformity upper and lower back pain.
5.Elevation right rib cage.

6. Surgical Strategy
• Segmental spinal instrumentation thoracic T3-L1 using 1/4-inch
stainless steel pedicle screw/rod construct.
• Posterior spinal fusion thoracic 3 to L1 using locally harvested
autogenous bone and morselized allograft.
• Multiple level spinal osteotomy for induction of flexibility for
correction of Lenke 1A curve.
• Intraoperative O-Arm neuronavigation.
• Intraoperative somatosensory evoked potentials and motor-
evoked potentials supervision.

7. Post-op Films
The patient is perfectly
balanced in both the sagittal
and coronal plane.

8. Pre-Op/Post-op Comparison
54°