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Clinical Neuroscience News, September 2013

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Case Study: Exaggerated Coronal Curves Fixed

Dr. Ahmad Latefi

A 16-year-old young woman was referred to us complaining of significant back pain mostly at the thoracolumbar junction. Her postural presentation revealed three abnormally exaggerated coronal curves, at least one of them presumed to be structural and the other(s) compensatory. She reports having been examined for scoliosis eight years earlier at which time mild idiopathic scoliosis was detected and a conservative treatment approach recommended. A review of those earlier films showed a clear progression of the curvatures, with the apex of the deformity at the T12-L1 site estimated at over 60 degrees. Physical examination showed that her sensory responses and reflexes were normal, her muscle strength 5/5, her general state of health good.

Before a treatment plan could be discussed, the patient was sent for a number of full-length x-rays, an MRI to visualize the spinal cord, and a CT scan of the cervical, thoracic and lumbar spine to assess the integrity of bony structures and the size of pedicles. Seeing clearly that the thoracolumbar curve was the site of the deformity and of the dynamic rotation, we recommended surgical correction, including insertion of instrumentation from T8 to L4 vertebral levels, followed by osteotomy and fusion.

During summer vacation in July, she underwent the proposed procedure, using intraoperative sensory and motor EPs to monitor integrity and CT scans to assess and plan for the correct placement of the multiple fixation screws that would anchor the instrumentation.

Fourteen days postoperatively the patient reported restored balance and receding pain. She is able to stand straight, head positioned normally over the midline of her pelvis. Long-cassette x-rays show her Cobb angle was now corrected to an acceptable 25 degrees. At her three-month follow-up, she had healed nicely, felt good, was back in school and very happy with her results.

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Case Study: Exaggerated Coronal Curves Fixed

AnteroPosterior and lateral preoperative x-ray showing thoracolumbar scoliosis in an adolescent patient

Case Study: Exaggerated Coronal Curves Fixed

AP and lateral postoperative x-ray in the above adolescent patient