A 16-year-old female presented with progressive adolescent idiopathic scoliosis. Her curve had increased from 40 degrees to 46 degrees over two years while wearing a brace. Pre-op x-rays showed a 46 degree thoracic curve. The indications for surgery were a progressive curve, pain, and deformity. The surgical strategy involved segmental spinal instrumentation from T2 to L1 using pedicle screws, multiple osteotomies from T5 to T10 including Smith-Peterson osteotomies, and posterior spinal fusion from T3 to L1. Post-op films showed the patient was well-balanced in the coronal and sagittal planes, and her symptoms resolved following surgery.

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

2. Patient History
14 year old female presented with progressive Adolescent
Idiopathic Scoliosis. Her curve was thought to have increased
20° over the duration of her treatment.
The patient wore a brace.
When she presented at my office, her curve was 40°.
Curve progressed to 46° two years from initial consultation.
The patient has 2-cm right rib hump, minimal left lumbar
fullness and what appears to be a gross thoracic shift to the right.

3. Pre-op X-rays
46°
46° 1AN curve with apex at T10,
which is fully flexible. The patient
has a significant right rib hump.

4. Bending X-rays

5. Indications for Surgery
1. Progressive adolescent idiopathic scoliosis, 1AN, 46 degree, right
thoracic curve.
2. Significant pain, thoracic and lumbar spine.
3. Cosmetic deformity of thoracic spine.
4. Failed conservative therapy.

6. Surgical Strategy
Segmental spinal instrumentation, T2 to L1 using 5.5 stainless
steel pedicle screw rod construct.
Multiple level osteotomies, T5 to T10, including Smith-Peterson
osteotomies for induction of flexibility for improvement of
adolescent idiopathic scoliosis.
Posterior spinal fusion, T3 to L1, using locally harvested
autogenic bone and allograft.
Removal of fractured facet under loupe magnification, T7 on the
left.
Plastic closure of the wound.
Intraoperative SSEP management.
Intraoperative fluoroscopy management.

7. Post-Op Films
The patient is well
balanced in the coronal
and sagittal planes.

8. Pre-Op/Post-op Comparison
46°

9. Pre-Op/Post-op Comparison
The patient’s symptoms
resolved following surgery,
and she is very happy with
her cosmetic outcome.