Adult scoliosis: Preoperative and postoperative radiographs and clinical appearance

(Panel A) Posteroanterior radiograph demonstrating 87.5° right thoracic scoliosis in a 36-year-old man with progressive back pain, shortness of breath with exercise, and worsening posture and self-image over time. He was diagnosed as a child, but never braced, and had no follow-up radiographs as an adult. His symptoms progressed during adulthood despite conservative treatments including physical therapy and weight loss. The air-fluid level in the stomach confirms that the radiograph was taken with the patient standing. There is a severe right thoracic curve with significant rotation and shoulder obliquity. Trunk alignment is good; there is no lateral listhesis and no congenital wedging.
(Panel B) Posterior view of the patient before surgery. Note the large right thoracic hump and skin crease on the left side under the scapula.
(Panel C) Postoperative thoracolumbar instrumentation and fusion, with improvement in preoperative scoliosis Cobb measurements.
(Panel D) Posterior view of the patient after surgery. Thoracic rib hump is significantly reduced, and the left chest wall has also been derotated noted by decreased skin crease and decreased "sunken" appearance. Shoulder height and scapulae are symmetric. Kyphosis has also been corrected, bringing shoulders back into proper alignment. The patient's preoperative pain has been relieved; he is now able to exercise without shortness of breath and has improved posture and self-image.