case review #17: 20 year old female with adolescent idiopathicscoliosis
TRANSCRIPT
Case Review:
20 year old female with Adolescent Idiopathic Scoliosis, 58° curvature.
Robert S Pashman, MDScoliosis and Spinal Deformity Surgerywww.eSpine.com
58°
Patient History
• The patient was diagnosed with scoliosis at age 16 with a curvature measuring 40°
• Her curvature continued to progress to 50°, and the patient opted to wait until after she graduated from college to proceed with surgery.
• The patient is a top level swimmer and water polo player, and very athletic in general.
• At the time of surgery, she was classified with a Type 2 curve that is 58° right thoracic with a structural upper thoracic curve measuring in excess of 45° with depression of the right shoulder.
Pre-op X-rays
58°
Bending X-raysThe patient has flexibility of the lumbar compensatory curve and on right and left side bending compensates well through the L- 1 vertebra. The apex is at T11-10 and the patient has a 2 cm rib hump and was preoped for a thoracoplastypending cosmetic results.
Indications for Surgery1. Kim/SRP type 1 type 2 adolescent/adult scoliosis, progressive,
58° thoracic curve. 2. Structural proximal thoracic curve 3. Documented progression with depression right shoulder. 4. Increasing upper and low back pain.
Surgical Strategy• Segmental spinal instrumentation thoracic 3 to lumbar 1 using a
5.5 stainless steel pedicle screw rod construct. • Posterior spinal fusion, thoracic 3 to lumbar 1 using locally
harvested autogenous bone, allograft putty and RH BMP. • Multiple level segmental osteotomy for fractional curve flexibility
induction. • Smith-Peterson osteotomy, T4-5, T5-6, T6-7, T7-8, T8-9, T10-11
and T11-12. • Intraoperative O-arm neuronavigation. • Plastic closure of wound.
Post-op Films• A 48° correction was
obtained• The patient is well
balanced in both the frontal and the sagittalplanes.
• She is very happy with the outcome of her surgery.10°
Pre-Op/Post-op Comparison
58° 10°