AIS: Double Major Curve, but still possible to do a very short fusion and obtain close to 100% correction.

Description

This 16-year-old female patient clearly had adolescent idiopathic scoliosis with a double major curve. Her thoracic spine curved 49º, and her lumbar spine curve 52º.

Usually when there is a thoracic and a lumbar curve, it’s possible to identify one curve as primary and the other as secondary. The primary curve is the “driving” curve—it’s actually forcing the other part of the spine to curve, creating a secondary curve. In that case, it’s possible to just fuse and fix the primary curve.

However, in this patient’s case, both curves were equally structural. It was necessary to correct both curves.

Treatment

Dr. Bridwell did a posterior spinal fusion with instrumentation.

Dr. Bridwell and his team know that, if at all possible, it’s better to fuse to L3 rather than L4 (the third lumbar—waistline level between the rib cage and pelvis —vertebrae rather than the fourth). That’s because if there’s a fusion all the way to L4, the patient loses more mobility in the spine.

To help the patient maintain a mobile lumbar spine, Dr. Bridwell stopped the fusion as L3. He used derotational and translational maneuvers to correct the curve. He used pedicle screws and rods to help hold the spine in a better alignment as the vertebrae fused and healed.

Result

After surgery, the patient’s thoracic curve was reduced to 17º, and her thoracic curve was reduced to 6º. At her 2 year follow-up appointment, she was doing very well.