A 16 years old male patient presented by progressive spinal deformity in the form of tilting of the spine to right side with elevation of left shoulder than right shoulder and abnormal gait and stance. The incidence started one and half years back. At the first the patient tried conservative treatment as bracing to support vertebral column and correction of scoliosis, and physiotherapy to strength muscles of the back, the patient did not improve on conservative treatment and deformity increased, the patient came to outpatients clinic and clinical assessment was done and advanced scoliotic deformity was observed,+ve Adam’s forward test, X-ray whole spine anteroposterior and lateral views in upright position, anteroposterior tilting to right and left in supine position to differentiate compensatory curve from structural scoliotic curve, Cobb’s angle was measured 60◦ (Cobb’s angle is an angle of deformity and if it measures more than 40◦ it means the patient will need surgical correction), also Risser grade was measured 4(Risser grade is a grade which assess the growth of vertebral column, grade 4 and 5 means no more growth), MRI dorsolumbar spine also was done.
The scoliotic curve started from the seventh thoracic vertebra to fourth lumbar vertebra and its center was at D12 and L1 vertebrae with mild compensatory curve above the main curve and reach to D4.
Cardiac and pulmonary assessment was done and the patient prepared for surgery which was done in form of transpedicular fixation of vertebral spine from the seventh thoracic vertebra to the fourth lumbar vertebra, correction of scoliotic curve and posterior dorsolumbar fusion, the Cobb’s angle is corrected from 60◦preoperative to be less than 5◦ postoperative and sagittal balance become normal. The patient returned gradually to normal life, and he is doing well.