Minimizing PSF levels to maximize young scoliosis patient’s range of motion

The patient’s lumbar curve flexed to less than 25 degrees, so posterior spinal fusion was performed on the thoracic 45-degree curve. See how she’s doing now.

The patient

The 12-year-old female presented with concern for spinal deformity. Initial curvature was 30-degree right thoracic curve and a 24-degree left lumbar curve. She was treated with a thoracic lumbar sacral orthosis (TLSO). Unfortunately, her curve progressed to over 45 degrees in the thoracic spine and 35 degrees in the lumbar spine.

The challenge

Surgery would be required, and the patient was active in sports. Her two curves raised the prospect of fusing many levels across the thoracic spine and lumbar spine. The more levels that are fused in surgery, the more loss of motion the patient will have after surgery.

The physicians


Kent L. Walker, D.O., pediatric orthopedic surgeon, Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine

Joshua W. Meier, M.D., pediatric orthopedic surgeon, Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine

The solution

Bending and traction images showed the lumbar curve was flexible and bent out to less than 25 degrees. This meant the patient was a candidate for a selective thoracic fusion, and fewer levels could be fused at the time of surgery.

The result

The patient underwent posterior spinal fusion for T2 to T12 in December 2019. She recovered well and has returned back to normal activities. She is now two years out from surgery and currently participates in cross-country, track, basketball and water tubing.

December 2021

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Use EpicLINK to refer a scoliosis patient to Norton Children’s Orthopedics of Louisville or Norton Leatherman Spine.

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