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Clinical Neuroscience News, September 2013

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Case Study: Two-Phase Scoliosis Intervention

Dr. Ahmad Latefi

A 28-year-old female native of a foreign country, currently studying in America, was referred to us in June 2012. She reported that she was diagnosed with adolescent idiopathic scoliosis, but that she deferred treatment until coming to this country. She also stated that the curve had progressed over time and that she finds it physically and cosmetically painful. Her general appearance revealed a pronounced dextroscoliosis that was concentrated in the proximal thoracic. Her right shoulder was mildly elevated compared to the left. The x-rays she brought with her confirmed the dextroscoliosis, but in order to get a more complete description of her deformity long-cassette films were ordered which included standing lateral and sidebending anteroposterior views. A CAT scan and an MRI of the cervical, thoracic and lumbar spine regions were also ordered.

Upon receipt of these new images, the patient was found to have thoracic scoliosis with a Cobb angle of 90 degrees. We recommended surgical correction consisting of T1 to T12 instrumentation, and T6 vertebral column resection; the two-phase operation was scheduled for two days in early September. Surgical intervention was carried out while sensory and motor responses were monitored; they remained at the patient’s preoperative baseline.

The patient returned for her post-op examination in late September, reporting some residual pain but otherwise very pleased. The visible hump in her thoracic spine was entirely gone. Her shoulders are now symmetrical and leveled and her head is in midline position, indicating that she is coronally balanced. Her Cobb angle has been reduced by half and is now at 40 degrees, the maximum possible without additional surgery. A temporary stabilization brace and external bone stimulator device were provided to hasten healing, but all the goals of the initial deformity surgery have been met. She is now standing and walking comfortably.  She is understandably happy with the improvements.

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Case Study: Two-Phase Scoliosis Intervention

(Left) Preoperative and (right) postoperative xrays of adolescent idiopathic scoliosis