21 year old male presented with Adult Idiopathic Scoliosis which progressed despite bracing. Dr. Pashman treated the patient with a posterior spinal fusion from T2-L1. Scoliosis curve was a KIM/SRP Classification 1.

1. Case Review:
21 year old male, with Adult
60°
Idiopathic Scoliosis which
progressed despite bracing.
42°
Robert S Pashman, MD
Scoliosis and Spinal Deformity Surgery
www.eSpine.com

2. Patient History
21-year-old male
Adolescent Idiopathic Scoliosis
Was braced as a child.
Noticed decreased height.
No other medical problems.
Right rib hump, moderate left lumbar fullness, balanced frontal
sagittal plane. Motor sensory examinations intact.

3. Pre-op X-rays
36 x 14 x-rays show a type
A/BN curve moderate rotation
lumbar spine, 60° curve with 42°
lumbar compensatory curve.
60° The patient has a short right
thoracic curve. This will be
studied with CT scan to rule out
42° a congenital abnormality, but the
patient would benefit from a
selective thoracic fusion.

4. Bending X-rays
On side bending, the
patient's lumbar spine to the
left centers over, on right
side bending, T12 comes to
the mid- Harrington or mid-
gluteal line, but clearly the
curve is well left of the mid
point.
On right side bending, the
lumbar curve is significantly
flexible from 42° to 27° with
significant derotation. The
proximal thoracic curve is
ridged at 35°, making this a
double thoracic curve.

5. Indications for Surgery
1. 2CN progressive adult idiopathic scoliosis.
2. Upper thoracic pain.
3. Thoracic kyphosis.
4. Rigid curved failed conservative therapy.

6. Surgical Strategy
The patient has a rigid 60° primary thoracic curve and this will
need release. That is why multiple levels osteotomies were done.
The plan is T2 to lumbar 1 because the lumbar spine was left
free for auto balance.
Segmental spinal instrumentation using a 5.5 stainless pedicle
screw, rod construct, thoracic 2 to lumbar 1.
Segmental osteotomy for release of rigid thoracic spine, 60°, T4,
T5, T6, T7, T8, T9 and T10.
Posterior spinal fusion, thoracic 2 to lumbar 1, using locally
harvested autogenous bone and croutons.
Intraoperative SSEPs.
Intraoperative fluoro.

7. Post-Op Films
The patient is well
balanced in the sagittal
and coronal planes.
He was very happy with
his outcome.
The patient returned to
weight lifting and his job
in the construction
industry one year post-op.

8. Pre-Op/Post-op Comparison
60°
42°