A very active 15 year old male presented with progressive Adolescent Idiopathic Scoliosis. His curve progressed after a recent growth spurt. The patient had scoliosis surgery, and returned to ROTC.

1. Case Review:
15 year old male with
55°
progressive Adolescent
Idiopathic Scoliosis
54°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
• 15 +7-year-old Risser 4 male
• Progressive Adolescent Idiopathic Scoliosis
• Very active student, ROTC participation
• Recent growth spurt
• No other contributing medical conditions.

3. Pre-op X-rays
The patient is a Risser 4.
55°
The characteristics of the curve
54° are a rigid 55° right thoracic, a
significantly rotated 54° lumbar
curve with a significant
thoracolumbar kyphosis
measuring 30°.

4. Bending Films
• On the right-sided lumbar
side bending the patient
displays neutrality as the
midline bisects Harrington
neutral vertebral rotation
between the L3-4 disk. The
thoracic right side- bending is
structural to about 36 degrees.
• Left side- bending shows a
significant flexibility of the
lumbar component which
reduces to approximately 20
degrees the apex L2-3 is still
rotated and does not
neutralize until the L3-4 disk.

5. Indications for Surgery
1. Lenke 1C versus 3, 51 degree right thoracic, 48 degree left
lumbar curve progressive adolescent idiopathic scoliosis.
2. A 3 cm right rib hump left flank fullness.
3. Progressive deformity with failed conservative therapy in a
adolescent.

6. Surgical Strategy
• Thoracic 3 to lumbar 3 segmental spinal instrumentation using ¼
inch stainless steel rod screw construct.
• Posterior spinal fusion thoracic 3 to lumbar 3 using locally
harvested autogenous bone with allograft extender.
• Multiple level Smith-Petersen osteotomy for induction of
flexibility and cosmetic result.
• Thoracic 6 to lumbar 1 bilateral facetectomy and midline
takedown.
• Intraoperative OR neuro navigation.
• Intraoperative motor evoked potential interpretation.
• Intraoperative plastic closure.

7. Post-op Films
• The patient did very well
post-operatively, and
returned to school after a
couple of weeks.

8. Pre-Op/Post-op Comparison
51°
48°