Scoliosis is defined as a structural deformity of the spine in all three dimensions and diagnosed if the Cobb angle is ≥10 degrees. Scoliosis is frequently associated with symptomatic spondylolisthesis, with an incidence ranging from 15% to 48%. The present report describes a patient with scoliosis associated with grade IV lumbar dysplastic spondylolisthesis who experienced the spontaneous correction of scoliosis after spondylolisthesis correction and fixation. The patient was a 12-year-old girl premenarche with an eight-month history of progressively increasing scoliosis, including back pain, left side leg pain, spinal deformity, and abnormal gait. She had been treated with a brace at the referring hospital but without significant improvement. Anteroposterior radiographs showed a long section of the spine, from T2 to L2, curving about 28.8 degrees to her right side, without evident pedicle rotation. Lateral radiographs revealed L5/S1 dysplastic type spondylolisthesis with >75% slippage (Meyerding Grade IV), a dome-shaped sacrum, and a flat back with butterfly sign. Correction of her spondylolisthesis by segmental instrumentation and interbody fusion of L5 and S1 resulted in almost complete resolution of her pain and scoliosis, with the outcome remaining stable seven years after surgery. These findings indicate that patients with scoliosis caused by spondylolisthesis may require only surgery for the latter condition, avoiding unnecessary surgery for scoliosis.

Object Pedicle screw fixation is a mainstay of thoracolumbar stabilization. Screw insertion using anatomical landmarks and fluoroscopy is common but can be technically challenging and generally involves substantial exposure to ionizing radiation. Computerized navigation has been reported to improve accuracy but is expensive and complex. The authors undertook this study to evaluate these 3 methods in comparison with a fourth technique using standard cervical distractor screws to mark the entry point and trajectory. Methods Four cadaveric human spines were used for this study. After an initial CT scan, 34 pedicle screws were inserted in each intact spine from T-1 to L-5 using the following 4 screw insertion guidance techniques (1 technique per specimen): use of anatomical landmarks, use of cervical distractor screws and spot fluoroscopy, fluoroscopy-based navigation, and fluoroscopy- and CT-based navigation (using merged imaging data). Postprocedural CT and anatomical dissection were then performed to evaluate screw position for site and degree of breach. Results The cervical distractor screw method had a breach rate of 5.9% versus 29.4%, 32.4%, and 20.6% for use of anatomical landmarks, fluoroscopic navigation, and fluoroscopic-CT navigation, respectively (p < 0.05). There is also a significant association between degree of medial and distal breach and the method of screw insertion (p < 0.05). Conclusions Cervical distractor screws as pedicle markers offer favorable insertion accuracy and reduction of radiation exposure compared with the other 3 methods used in clinical practice.

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