An adolescent girl presented with an atypical scoliotic curve, pelvic obliquity, back pain, and lower-extremity paresthesias. A workup revealed generalized primary torsion dystonia. The condition was refractory to medical treatment and necessitated implantation of a deep brain stimulator. The scoliosis required operative correction, and the patient underwent posterior spinal arthrodesis with hook-rod instrumentation, which resulted in successful correction through 7 years of follow-up.
The differential diagnosis for adolescent scoliosis should include dystonia as a potential cause, especially when a patient presents with muscular contractures, an atypical scoliotic curve, pelvic obliquity, or changing curve characteristics.
1Departments of Orthopaedic Surgery (A.K.B. and M.J.S.) and Neurological Surgery (R.N. and D.M.W.), Allegheny General Hospital, Pittsburgh, Pennsylvania
aE-mail address for A.K. Bhandutia: firstname.lastname@example.org