Severe Double Major Curve Scoliosis in Adolescent Female

A 13-year-old adolescent girl presented with a history of progressive scoliosis, which had become increasingly noticeable to her family due to the visible trunk deformity. Clinically, she demonstrated a severe S-shaped spinal deformity typical of a double major curve pattern, with both thoracic and lumbar regions significantly involved. The thoracic curve caused rib prominence and asymmetry of the chest wall, while the lumbar curve contributed to waistline imbalance and pelvic tilt. On forward bending, there was a marked rib hump, a clear indication of rotational deformity associated with the scoliotic changes.

Preoperative standing X-rays of the spine revealed a severe double major curve: a large right thoracic curve and a compensatory left lumbar curve, both exceeding the threshold that necessitates surgical intervention. The severity of these curves posed risks of progression, cosmetic disfigurement, and potential compromise of pulmonary function in the future. The overall spinal balance was poor, with one shoulder higher than the other and a tilted pelvis, which further emphasized the deformity. Given the extent of the curvature, posterior spinal instrumentation with fusion was indicated in order to restore alignment, achieve curve control, and prevent further worsening of the deformity.