Cassandra Akpan, center, rehearses with her colleagues. Anyone who thought she would give up dancing just because of the rods, hooks, screws and other hardware implanted in her back simply didn't know the depth of this ballerina's courage.

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Fourteen-year-old Cassandra Akpan, a dedicated ballerina, knew something was wrong when her right shoulder blade suddenly popped out of place.

Her spine had somehow veered off course as she grew, creating a pronounced arc. On an X-ray, it looked like a question mark.

While a normal spine has a curve of zero degrees, the degree of curvature in her upper vertebrae was 56 and her diagnosis was scoliosis. As in other scoliosis cases, the bend in her spine was three-dimensional, like a twisted garden hose, said her Tucson surgeon, Dr. Kent Vincent.

Akpan's case was far too severe for the "watch and wait" approach for most scoliosis patients. It was also too serious for a brace. Akpan needed back fusion — major surgery that typically lasts five or six hours and has serious risks, including neurovascular injury and paralysis. The surgery involves attaching rods, hooks, screws and cross links to the spine, which act like rebar. Akpan's rods are titanium.

Despite those rods, Akpan is dancing again.

Now 16, she will, for the first time, dance a solo in the Tucson Regional Ballet's annual performance of "A Southwest Nutcracker," which has three shows this weekend. She will perform her solo during the Saturday matinee performance. This "Nutcracker" puts a local twist on the traditional ballet by being set in Tucson in the 1880s.

In a letter Akpan wrote to Vincent after the surgery, she expressed gratitude, saying the surgeon had changed her life, "but more importantly you haven't changed it at all."

She didn't know back then how much she would progress, but says she is "so blessed" to be where she is now.

As the Native American queen who appears in the second act of the "Nutcracker," Akpan makes a regal entrance for her en pointe solo, as she's carried in above the heads of two male dancers.

Raising her arms in the air to the music of Tchaikovsky's "Arabian Dance," the tall, lean dancer is statuesque and graceful at the same time. In her dance, in which she's surrounded by a corps of other ballerinas, the University High School junior does several attitude turns, an arabesque and drops into the splits.

Akpan says her arabesque is not quite the same as it was, and she is more limited than most dancers in back arches. But to an outside observer, the only clear evidence of her surgery when she dances is the scar on her back.

Her mother, Becky Akpan, had taped pictures of her daughter on the walls of the Tucson Medical Center operating room before the surgery in December 2006.

"I wanted them to know this is a very special person who wants to dance again," she explained. "It would have killed me to tell her that her back would be much straighter, but that she would be unable to dance at any level comparable to what she was accustomed."

Her passion to dance seemed to fuel Akpan's recovery from the surgery, which required remaining completely straight and hospitalized for a week.

Like many young scoliosis patients, she had her surgery during a school holiday. Vincent says he has two or three scheduled this December. He completed 14 of the surgeries last summer and averages 20 to 25 per year at Tucson Medical Center. Most of his patients are girls and young women, as they are eight times more likely than males to develop curvatures serious enough to require treatment.

"The surgery's a big deal, no question about it," Vincent said. "What I tell the kids who are high-level competitors in sports and high-level dancers, is that there are probably going to be some things to do with flexibility that you are going to be limited in. …

"She is a very good example of what you can do. And she in particular has a very good attitude."

He added that most flexibility comes from the lower back and not the upper area, where Akpan had her surgery and where most scoliosis surgery occurs.

Akpan missed only a few days of school, though in her first days back, walking was difficult. After the surgery she gained two inches, bringing her already tall frame to 6 feet 1 1/2 inches.

She returned to dancing in March 2007. Her sense of balance was off and bending was painful. Though she began slowly, she eventually got back up to her previous time commitment, dancing about 15 hours per week.

"I wasn't quite sure how it was going to affect her. But on the first day she came back, I saw it was going to be no problem. She took her time and knew to be very body-aware," said Sheri Giller, who was Akpan's ballet instructor during her recovery.

"Obviously she couldn't bend her back like a normal dancer because of the rods, or lift her leg very high. But as time progressed, she improved. She gained strength, courage and self-confidence, and she pulled it off."

Akpan, a member of the Tucson Regional Ballet's senior company, has inspired her teachers and fellow dancers.

"She has been with me since she was 7. Needless to say, I am very fond of her and am grateful she is with us," said the ballet's artistic director, Linda Walker. "I also know how much dance means to Cassie."

That first year back, Akpan wasn't well enough to perform in an annual spring ballet show.

"That was the first time I saw her cry about all this," her mother said.

Had she not undergone surgery, Akpan's spinal curve would have worsened by an average of about 1 degree per year after she finished growing, Vincent said. Over time the curve would become quite noticeable. Curvatures of 70 degrees to 80 degrees will start impinging on lung functions, he said.

This year will mark Akpan's eighth time performing in the local "Nutcracker." But it's a special year.

"It's my dream role," she said of the Native American queen. She also has smaller roles as an ocotillo, a flower and as snow during the weekend performances.

Giller said Akpan had felt typecast in the past because of her height, often earning what dancers call "character roles."

"She was reaching for a solo role, she got it and she deserves it," Giller said.

"To come back better than ever, that's a success story if I ever heard one."