A 14-year-old girl previously diagnosed with adolescent idiopathic scoliosis presented to our institution for consultation with regard to operative treatment of scoliosis. Her spinal curvature was first noticed by her mother 5 years before presentation and had been managed with a thoracolumbosacral orthosis. However, her curve progressed to the point that it required a surgical procedure. Her preoperative physical examination showed uneven shoulder levels (right higher than the left), right rib prominence on Adam’s forward bend test, and a 25° thoracic trunk rotation measured by a scoliometer.
Per routine practice, standard posteroanterior and lateral standing and traction spine radiographs were obtained to guide preoperative planning. The standing views demonstrated an 82° thoracolumbar curve with an apex at T12, 5 lumbar vertebrae, and a grade-0 Risser sign (Fig. 1). However, the patient’s traction radiograph showed only 4 lumbar vertebrae.
What is the diagnosis?
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