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A 13-year-old female presents to clinic after being told that she has scoliosis. She has no pain and has had no treatment up to this point. Figure A shows her radiograph with a 32° curve. An MRI showed no spinal cord abnormalities. What is the most appropriate treatment and expected outcome given her age and degree of scoliosis?
Observation with a 100% chance of progression to >50° deformity
Rigid TLSO for 2 hours/day with a 75% decrease in the need for surgery
Rigid TLSO for 13 hours/day with a 50% decrease in the need for surgery
Rigid TLSO for 24 hours/day with a 100% decrease in the need for surgery
Posterior spinal fusion
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A 16-year-old female with adolescent idiopathic scoliosis undergoes posterior spinal fusion with instrumentation. The thoracic pedicle screws were placed using a tap 1 mm smaller than the screw diameter and a straightforward trajectory that runs parallel to the superior endplate. This techniques allows for which of the following:
Anatomic placement of the screws.
Increased depth insertion of the screws.
Increased maximal insertional torque.
Decreased resistance to screw pullout.
Decreased stability of the construct.
A 12-year-old girl who is 3 months postmenarchal undergoes full-time brace treatment for scoliosis. The posteroanterior radiograph (Figure A ) taken at that time reveals a right thoracic curve measures 28 degrees, and the left lumbar curve measures 23 degrees. At age 15, after 3 years of bracing, a repeat posteroanterior radiograph is obtained, now revealing a right thoracic curve measuring 11 degrees and the left lumbar curve measuring 19 degree, and Risser 4. Which statement best represents the indicated course of action in this patient?
Discontinuation of bracing as she has reached skeletal maturity.
Continue full-time bracing until skeletal maturity.
Continue nocturnal bracing until skeletal maturity.
Posterior spinal fusion.
MRI of the cervical, thoracic and lumbar spine.
The 'Risser sign' is one of the most commonly used markers for skeletal maturation and growth potential in patients with adolescent idiopathic scoliosis. What 'Risser sign' has been shown to correlate with the greatest velocity of skeletal linear growth?
Skeletal maturity is an important variable in the progression of idiopathic scoliosis. Figures A-E are radiographs showing varying stages of skeletal maturity. The patient represented by which Figure would be expected to have the highest risk of progression of an idiopathic scoliotic curve?
A 12-year-old female is referred to the office by a community orthopaedic surgeon concerned that her shoulders appear to be at different heights. With Adam's forward bending, she is noted to have a significant right thoracic rib prominence. She denies pain. A detailed neurological examination reveals no abnormalities. Radiographs of her spine show an apex left lumbar curve measuring 32 degrees and an apex right thoracic curve measuring 28 degrees. She had her first menses last month and her Tanner-Whitehouse staging is consistent with an adolescent steady state. The most appropriate treatment would be?
Observation and referral to an endocrinologist
The orthosis shown in Figure A is indicated for the treatment of the spinal deformity shown in which of the following radiographs?
Which of the following methods of determining skeletal maturity correlates most closely with the curve acceleration phase for children with idiopathic scoliosis?
Lenke classification method
Greulich and Pyle method
A 13-year-old girl is referred to the orthopedic clinic for evaluation of scoliosis. She denies back pain and states she began her menses 3 months ago. On Adams forward bending, she measures 6 degrees. She has 5 of 5 motor strength in all muscles groups in her lower extremities and symmetric patellar and Achilles reflexes. A standing PA and lateral radiograph is shown in Figures A and B. All of the following should be performed as part of her evaluation EXCEPT:
Evaluation of leg lengths
Assessment of abdominal reflexes
Evaluation of waist asymmetry
Evaluation for café-au-lait spots
In patients with adolescent idiopathic scoliosis, bracing is indicated in which of the following conditions:
Any patient with a curve of greater than 25 degrees
A 11- year-old boy boy with a Cobb angle curve of 50 degrees
A premenarchal girl with a Cobb angle curve of 30 degrees
A growing child with 6 degrees of progression with a 12 degree curve
A girl who is Risser 4, Sanders 7, with a 30 degree curve.
A 12-year-old girl who is Risser stage 3 has had intermittent mild midback pain for the past 4 weeks. The pain is worse after prolonged sitting and after carrying a heavy backpack at school. She occasionally takes acetaminophen, but the pain does not limit sport activities. Examination reveals a mild right rib prominence during forward bending. Neurologic examination is normal. Radiographs show a 20-degree right thoracic scoliosis with no congenital anomalies or lytic lesions. Management should consist of
back muscle stretching and reduced weight in the backpack.
consultation with a pain management specialist.
MRI of the thoracic spine.
a technetium Tc 99m bone scan.
a thoracolumbosacral orthosis.
What risk factor is most associated with progression of idiopathic scoliosis to a curve requiring surgery?
Curve magnitude of more than 20 degrees at menarche
Curve magnitude of more than 30 degrees at the peak height velocity
Curve magnitude of more than 30 degrees at skeletal age 12 years
Curve magnitude of more than 30 degrees at Risser grade 2
Curve flexibility of less than 50% at Risser grade 2
A 12-year-old female presents with a left thoracic rib prominence. Physical exam shows absent abdominal reflexes in the upper and lower quadrants on the left side, but present on the right. A PA standing radiograph is shown in Figure A. What is the next step in management?
Observation with repeat radiographs in 6 months
Bracing with a thoraco-lumbar-sacral orthosis
Magnetic resonance imaging (MRI)
Posterior spinal fusion with instrumentation
Anterior and posterior spinal fusion with instrumentation
An isolated long-segment instrumented posterior spinal fusion is considered in which of the following clinical situations?
A 13-year old female, Risser 3, with adolescent idiopathic scoliosis (AIS) and a Cobb angle of 55 degrees
A 5-year old male, with juvenile idiopathic scoliosis (JIS) and a Cobb angle of 55 degrees
A 2-year old female with infantile idiopathic scoliosis (IIS), a flexible curve with a Cobb angle of 35°, and a RVAD of 25°
A 7-year-old with a progressive spinal deformity. Imaging demonstrates a T9 failure of formation with contralateral segmentation failure
A 13-year old female Risser 2, with AIS and a Cobb angle of 27 degrees
In the treatment of thoracolumbar idiopathic scoliosis using an anterior single rod technique with interbody cages, which of the following variables has been associated with pseudoarthrosis.
Thoracic curve coronal correction of > 40%
Thoracolumbar/lumbar curve coronal correction > 50%
Smaller adolescents (<50 kg)
Failure to maintain lumbar lordosis of > 45 degrees
Thoracic hyperkyphosis (>40 degrees )
A mother and her 16-year-old daughter present to your clinic because the daughter has noticed asymmetries in her back. She has no back pain and no neurologic symptoms. She is two years post-menarcheal. After a complete history and physical, you order PA thoracolumbar radiograph, which is seen in figure A. The cobb angle is 38 degrees. When discussing the natural history of the disease, you tell the family they should expect:
difficulty with vaginal child birth in the future.
decreased pulmonary function in the future
to undergo an MRI to rule out any underlying neurologic pathology, as this is an abnormal curve
an increased risk of chronic back pain over her lifetime
this curve magnitude has the highest curve progression rate without operative intervention
When compared to normal controls, adults with untreated idiopathic scoliosis and a Cobb angle of greater than 60 degree at the time of skeletal maturity have a higher rate of which of the following?
Acute and chronic back pain
Limitation in activities of daily living