Adolescent Lumbar Spondylolisthesis and a Double Major Curve Scoliosis-are they Related? Can we Preserve Lumbar Motion

The coexistence of idiopathic scoliosis and spondylolisthesis is well documented, yet their etiological relationship remains unclear. In some cases, scoliosis may arise secondarily due to the mechanical impact of spondylolisthesis, while in others, both conditions occur independently. We report the case of a 9-year-old girl with symptomatic grade III isthmic spondylolisthesis and mild lumbar scoliosis. Conservative management failed due to non-compliance, leading to progression of both the vertebral slip and spinal curvature. Surgical stabilization of the spondylolisthesis was performed, but scoliosis continued to worsen, ultimately requiring posterior thoracic fusion T3-T12 - preserving motion of the lumbar spine. Following this, the lumbar curve improved spontaneously. At three-year follow-up, the patient remained pain-free, with reduced asymmetry and preserved function. This case illustrates the diagnostic and therapeutic challenges in managing concomitant scoliosis and spondylolisthesis. Scoliotic curves in this context may be classified as idiopathic, spasm-related (functional), or olisthetic (structural). Identifying the nature of the scoliosis is essential for selecting the appropriate treatment strategy and determining whether spinal fusion should address one or both deformities. Independent idiopathic curves should be managed per standard guidelines, whereas secondary curves may improve after addressing the underlying spondylolisthesis. In patients with coexisting scoliosis and spondylolisthesis, careful assessment is needed to distinguish between idiopathic and secondary curves. Timely surgical intervention in symptomatic spondylolisthesis may prevent or reverse associated deformity, but progressive concomitant idiopathic scoliosis may still require specific surgical management.