Abstract
Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain. Posterior-only approach with rod and screw corrective manipulation to add strength of contra bending manipulation has correction achievement similar to that obtained by conventional combined anterior release and posterior approach. It also avoids the complications related to the thoracic approach. We reported a case of 25-year-old male adult idiopathic scoliosis with double curve. It consists of main thoracic curve of 150 degrees and lumbar curve of 89 degrees. His curve underwent direct contra bending posterior approach using rod and screw corrective manipulation technique to achieve optimal correction. After surgery the main thoracic Cobb angle becomes 83 degrees and lumbar Cobb angle becomes 40 degrees, with 5 days length of stay and less than 800 mL blood loss during surgery. There is no complaint at two months after surgery; he has already come back to normal activity with good functional activity.
Highlights
Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain [1, 2]
Proximal thoracic Cobb angle is 25 degrees, lower end vertebrae (LEV) is at T5, upper end vertebrae (UEV) is at T2, and the apex is at T4
Main thoracic Cobb angle is 150 degrees, lower end vertebrae (LEV) is at T11, upper end vertebrae (UEV) is at T4, and the apex is at T7, whereas the lumbar Cobb angle is 89 degrees, lower end vertebrae (LEV) is at lumbar 5 (L5), upper end vertebrae (UEV) is at T12, and the apex is at L3 (Figures 2(e) and 2(f))
Summary
Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain [1, 2]. Type 2 is idiopathic adult scoliosis of the thoracic and/or lumbar spine which progresses in adult life and is usually combined with secondary degeneration and/or imbalance. Some patients had no surgical treatment or surgical correction or fusion in adolescence in the thoracic or thoracolumbar spine. The treatment of severe idiopathic scoliosis with the main curve more than 80 degrees was performed by an anterior release with an open thoracotomy [2, 3]. The difference between the rod and screw corrective manipulation approach and the previous one is the management of spinal column (Figure 1). Spinal column in the previous technique was attacked by anterior release and/or corpectomy procedure to weakened the column and make it easy to be manipulated. The previous technique has a lot of morbidity risks than the technique which was applied in this case
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