summary Adolescent Idiopathic Scoliosis is a coronal plane spinal deformity which most commonly presents in adolescent girls from ages 10 to 18. Diagnosis is made with full-length standing PA and lateral spine radiographs. Treatment can be observation, bracing, or surgical management depending on the skeletal maturity of the patient, magnitude of deformity, and curve progression. Epidemiology Incidence most common type of scoliosis incidence of 3% for curves between 10 to 20° incidence of 0.3% for curves > 30° Demographics most commonly presents in children 10 to 18 yrs 10:1 female to male ratio for curves > 30° 1:1 male to female ratio for small curves right thoracic curve most common left thoracic curves are rare and indicate an MRI to rule out cyst or syrinx Etiology Pathophysiology unknown potential causes multifactorial hormonal (melatonin) brain stem proprioception disorder platelet calmodulin abnormal development of neurocentral synchodrosis (NCS) cartilaginous plate that forms between the centrum and posterior neural arches closure occurs in characteristic order cervical NCS by 5-6 years old lumbar NCS by 11-12 years old thoracic NCS by 14-17 years old most have a positive family history Curve Progression risk factors for progression (at presentation) curve magnitude before skeletal maturity > 25° before skeletal maturity will continue to progress after skeletal maturity > 50° thoracic curve will progress 1-2° / year > 40° lumbar curve will progress 1-2° / year remaining skeletal growth younger age < 12 years at presentation Tanner stage (< 3 for females) Risser Stage (0-1) Risser 0 covers the first 2/3rd of the pubertal growth spurt correlates with the greatest velocity of skeletal linear growth open triradiate cartilage peak growth velocity is the best predictor of curve progression in females it occurs just before menarche and before Risser 1 (girls usually reach skeletal maturity 1.5 yrs after menarche) most closely correlates with the Tanner-Whitehouse III RUS method of skeletal maturity determination if curve is >30° before peak height velocity there is a strong likelihood of the need for surgery curve type thoracic more likely to progress than lumber double curves more likely to progress than single curves Classification King-Moe Classification five part classification to describe thoracic curve patterns and help guide surgeons implanting Harrington instrumentation link to King-Moe classification (not testable) Lenke Classification more comprehensive classification based on PA, lateral, and supine bending films helps to decide upon which curves need to be included within the fusion construct link to Lenke classification (not testable) Presentation School screening patients often referred from school screening where a 7° curve on scoliometer during Adams forward bending test is considered abnormal 7° correlates with 20° coronal plane curve Physical exam special tests Adams forward bending test axial plane deformity indicates structural curve forward bending sitting test can eliminate leg length inequality as cause of scoliosis other important findings on physical exam leg length inequality midline skin defects (hairy patches, dimples, nevi) signs of spinal dysraphism shoulder height differences truncal shift rib rotational deformity (rib prominence) waist asymmetry and pelvic tilt cafe-au-lait spots (neurofibromatosis) foot deformities (cavovarus) can suggest neural axis abnormalities and warrant a MRI asymmetric abdominal reflexes perform MRI to rule out syringomyelia Imaging Radiographs recommended views standing PA and lateral Cobb angle > 10° defined as scoliosis intra-interobserver error of 3-5° spinal balance coronal balance is determined by alignment of C7 plumb line to central sacral vertical line sagittal balance is based on C7 plumb from center of C7 to the posterior-superior corner of S1 stable zone between lines drawn vertically from lumbosacral facet joints stable vertebrae most proximal vertebrae that is most closely bisected by central sacral vertical line neutral vertebrae rotationally neutral (spinous process equal distance to pedicles on PA xray) end vertebrae end vertebra is defined as the vertebra that is most tilted from the horizontal apical vertebra apical vertebrae the apical vertebraeis the disk or vertebra deviated farthest from the center of the vertebral column clavicle angle best predictor of postoperative shoulder balance MRI should extend from posterior fossa to conus purpose is to rule out intraspinal anomalies indications to obtain MRI atypical curve pattern (left thoracic curve, short angular curve, apical kyphosis) rapid progression excessive kyphosis structural abnormalities neurologic symptoms or pain foot deformities asymmetric abdominal reflexes a syrinx is associated with abnormal abdominal reflexes and a curve without significant rotation Treatment Based on skeletal maturity of patient, magnitude of deformity, and curve progression Nonoperative observation alone indications cobb angle < 25° technique obtain serial radiographs to monitor for progression bracing indication cobb angle from 25° to 45° only effective for flexible deformity in skeletally immature patient (Risser 0, 1, 2) goal is to stop progression, not to correct deformity outcomes 50% reduction in need for surgery with compliant brace wear of at least 13 hours a day poor prognosis with brace treatment associated with poor in-brace correction hypokyphosis (relative contraindication) male obese noncompliant (effectiveness is dose-related) the number needed to treat (NNT) is four in highly compliant patients Sanders staging system predicts the risk of curve progression despite bracing to >50 degrees in Lenke type I and III curves uses anteroposterior hand radiograph and curve magnitude to assess risk of progression despite bracing Operative treatment posterior spinal fusion indications cobb angle > 45° can be used for all types of idiopathic scoliosis remains gold standard for thoracic and double major curves (most cases) anterior spinal fusion indications best for thoracolumbar and lumbar cases with a normal sagittal profile anterior / posterior spinal fusion indications larges curves (> 75°) or stiff curves young age (Risser grade 0, girls <10 yrs, boys < 13 yrs) in order to prevent crankshaft phenomenon Techniques Bracing recommended for 16-23 hours/day until skeletal maturity or surgical intervention deemed necessary (actual wear minimum 12 hours required to slow progression) brace types curves with apex above T7 Milwaukee brace (cervicothoracolumbosacral orthosis) extends to neck for apex above T7 apex at T7 or below TLSO Boston-style brace (under arm) Charleston Bending brace is a curved night brace bracing success is defined as <5° curve progression bracing failure is defined 6° or more curve progression at orthotic discontinuation (skeletal maturity) absolute progression to >45° either before or at skeletal maturity, or discontinuation in favor of surgery skeletal maturity is defined as Risser 4 <1cm change in height over 2 visits 6 months apart 2 years postmenarchal Posterior spinal fusion fusion levels goals fusion should include enough levels to adequately maintain sagittal and coronal balance while being as minimal as safely possible to preserve motion typical fusion from proximal end vertebra to one or two levels cephalad to the stable vertebra double and triple major curves fuse to the distal end vertebra Harrington technique recommends one level above and two levels below the end vertebrae if these levels fall wilthin the stable zone Moe technique recommends fusion to the neutral vertebrae Lenke technique recommends including all major curves in the fusion and minor curves that are not flexible or are kyphotic L5 level Cochran found increase incidence of low back pain with fusion to L5, and to a lesser extent L4. therefore, whenever possible, avoid fusion to L4 and L5 pelvis it is almost never required to fuse to the pelvis in idiopathic scoliosis pedicle screw fixation screw insertional torque correlates with resistance to screw pullout resistance to screw pullout increases by undertapping by 1mm curve correction segmental pedicle screw fixation allows increased coronal plane correction while lessening the need for anterior releases ASF with instrumentation advantage better correction while saving lumbar fusion levels disadvantage increased risk of pseudarthrosis when thoracic hyperkyphosis is present fusion levels typically fuse from end vertebra to end vertebra Neurologic Monitoring monitoring with somatosensory-evoked potentials (SSEPs) and/or motor-evoked potentials (MEPs) is now the standard of care motor-evoked potentials can provide an intraoperative warning of impending spinal cord dysfunction neurologic event defined as drop in amplitude of > 50% if neurologic injury occurs intraoperatively consider check for technical problems check blood pressure and elevate if low check hemoglobin and transfuse as necessary lessen/reverse correction administer Stagnaras wake up test remove instrumentation if the spine is stable Complications Neurologic injury paraplegia is 1:1000 increased risk with kyphosis, excessive correction, and sublaminar wires Pseudoarthrosis (1-2%) presents as late pain, deformity progression, and hardware failure an asymptomatic pseudarthrosis with no pain and no loss of correction should be observed Infection (1-2%) presents as late pain incision often looks clean Propionibacterium acnes most common organism for delayed infection (requires 2 weeks for culture incubation) attempt I&D with maintenance of hardware if not loose and within 6 months Flat back syndrome early fatigability and back pain due to loss of lumbar lordosis rare now that segmental instrumentation addresses sagittal plane deformities decreased incidence with rod contouring in the sagittal plane and compression/distraction techniques treat with revision surgery utilizing posterior closing wedge osteotomies anterior releases prior to osteotomies aid in maintenance of correction Crankshaft phenomenon rotational deformity of the spine created by continued anterior spinal growth in the setting of a posterior spinal fusion can occur in very young patients when PSF is performed alone and the anterior column is allowed continued growth avoided by performing anterior diskectomy and fusion with posterior fusion in very young patients SMA syndrome (superior mesenteric artery [SMA] syndrome) compression of 3rd part of duodenum due to narrowing of the space between SMA and aorta SMA arises from anterior aspect of aorta at level of L1 vertebrae presents with symptoms of bowel obstruction in first postoperative week associated with electrolyte abnormalities nausea, bilious vomiting, weight loss risk factors height percentile <50%; weight percentile < 25% sagittal kyphosis treat with NG tube and IV fluids Hardware failure late rod breakage can signify a pseudarthrosis Prognosis Natural history increased incidence of acute and chronic pain in adults if left untreated curves > 90° are associated with cardiopulmonary dysfunction, early death, pain, and decreased self image
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. PSF for idiopathic scoliosis Lindsay Andras David L. Skaggs Spine - Adolescent Idiopathic Scoliosis
QUESTIONS 1 of 32 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ18.41) The neurocentral synchondrosis (NCS) develops between which 2 spinal elements and closes in which order? QID: 212937 Type & Select Correct Answer 1 Centrum & anterior neural arches; cervical, thoracic, lumbar 8% (168/2187) 2 Centrum & anterior neural arches; cervical, lumbar, thoracic 14% (296/2187) 3 Centrum & posterior neural arches; cervical, thoracic, lumbar 30% (652/2187) 4 Centrum & posterior neural arches; lumbar, thoracic, cervical 9% (205/2187) 5 Centrum & posterior neural arches; cervical, lumbar, thoracic 38% (823/2187) N/A Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (SBQ18SP.32) 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? QID: 211454 FIGURES: A Type & Select Correct Answer 1 Observation with a 100% chance of progression to >50° deformity 2% (54/2324) 2 Rigid TLSO for 2 hours/day with a 75% decrease in the need for surgery 1% (20/2324) 3 Rigid TLSO for 13 hours/day with a 50% decrease in the need for surgery 86% (1995/2324) 4 Rigid TLSO for 24 hours/day with a 100% decrease in the need for surgery 8% (181/2324) 5 Posterior spinal fusion 3% (59/2324) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ14.38) 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: QID: 5448 Type & Select Correct Answer 1 Anatomic placement of the screws. 9% (384/4265) 2 Increased depth insertion of the screws. 7% (294/4265) 3 Increased maximal insertional torque. 65% (2758/4265) 4 Decreased resistance to screw pullout. 17% (733/4265) 5 Decreased stability of the construct. 1% (37/4265) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ13.138) 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? QID: 4773 FIGURES: A Type & Select Correct Answer 1 Discontinuation of bracing as she has reached skeletal maturity. 66% (2987/4527) 2 Continue full-time bracing until skeletal maturity. 14% (638/4527) 3 Continue nocturnal bracing until skeletal maturity. 18% (807/4527) 4 Posterior spinal fusion. 0% (18/4527) 5 MRI of the cervical, thoracic and lumbar spine. 1% (41/4527) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ13.61) 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? QID: 4696 Type & Select Correct Answer 1 Risser 0 55% (2948/5317) 2 Risser I 14% (734/5317) 3 Risser II 18% (938/5317) 4 Risser III 10% (511/5317) 5 Risser IV 3% (153/5317) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ12SP.34) A 17-year-old girl with severe adolescent idiopathic scoliosis requires an osteotomy in the lumbar spine to correct her saggital imbalance. Figure A shows the pre-operative plan and surgical technique for this procedure. What would be the most common complication with this type of spinal column osteotomy? QID: 3732 FIGURES: A Type & Select Correct Answer 1 Spinal cord ischemia 9% (160/1853) 2 Descending aorta injury 3% (63/1853) 3 Pseudoathrosis 49% (913/1853) 4 Pseudomeningocele 6% (112/1853) 5 Neurologic deficit 32% (585/1853) L 5 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ12.144) 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? QID: 4504 FIGURES: A B C D E Type & Select Correct Answer 1 A 9% (553/6011) 2 B 3% (203/6011) 3 C 80% (4815/6011) 4 D 5% (289/6011) 5 E 2% (113/6011) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (OBQ12.176) 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? QID: 4536 Type & Select Correct Answer 1 Posterior spinal fusion 5% (260/4790) 2 Spinal manipulations 0% (20/4790) 3 Observation and referral to an endocrinologist 8% (365/4790) 4 Thoracolumbosacral orthosis 86% (4115/4790) 5 Halo-gravity traction 0% (3/4790) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ12.178) The orthosis shown in Figure A is indicated for the treatment of the spinal deformity shown in which of the following radiographs? QID: 4538 FIGURES: A B C D E F Type & Select Correct Answer 1 Figure B 3% (121/4603) 2 Figure C 1% (39/4603) 3 Figure D 3% (127/4603) 4 Figure E 91% (4199/4603) 5 Figure F 2% (97/4603) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ12.70) Which of the following methods of determining skeletal maturity correlates most closely with the curve acceleration phase for children with idiopathic scoliosis? QID: 4430 Type & Select Correct Answer 1 Lenke classification method 4% (200/4524) 2 Greulich and Pyle method 5% (231/4524) 3 Oxford method 2% (83/4524) 4 Tanner-Whitehouse III 38% (1702/4524) 5 Risser sign 50% (2271/4524) L 5 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ11.49) 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: QID: 3472 FIGURES: A B Type & Select Correct Answer 1 Evaluation of leg lengths 4% (132/3677) 2 Assessment of abdominal reflexes 3% (118/3677) 3 Evaluation of waist asymmetry 3% (95/3677) 4 Evaluation for café-au-lait spots 2% (68/3677) 5 MRI 88% (3244/3677) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ09SP.17) In patients with adolescent idiopathic scoliosis, bracing is indicated in which of the following conditions: QID: 3380 Type & Select Correct Answer 1 Any patient with a curve of greater than 25 degrees 3% (105/3360) 2 A 11- year-old boy boy with a Cobb angle curve of 50 degrees 6% (187/3360) 3 A premenarchal girl with a Cobb angle curve of 30 degrees 80% (2676/3360) 4 A growing child with 6 degrees of progression with a 12 degree curve 7% (248/3360) 5 A girl who is Risser 4, Sanders 7, with a 30 degree curve. 4% (125/3360) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07PE.98) 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 QID: 6158 Type & Select Correct Answer 1 back muscle stretching and reduced weight in the backpack. 72% (933/1302) 2 consultation with a pain management specialist. 1% (8/1302) 3 MRI of the thoracic spine. 8% (110/1302) 4 a technetium Tc 99m bone scan. 1% (14/1302) 5 a thoracolumbosacral orthosis. 18% (232/1302) L 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07PE.25) What risk factor is most associated with progression of idiopathic scoliosis to a curve requiring surgery? QID: 6085 Type & Select Correct Answer 1 Curve magnitude of more than 20 degrees at menarche 2% (23/1009) 2 Curve magnitude of more than 30 degrees at the peak height velocity 62% (622/1009) 3 Curve magnitude of more than 30 degrees at skeletal age 12 years 8% (78/1009) 4 Curve magnitude of more than 30 degrees at Risser grade 2 26% (259/1009) 5 Curve flexibility of less than 50% at Risser grade 2 2% (20/1009) L 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ07.79) 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? QID: 740 FIGURES: A Type & Select Correct Answer 1 Observation with repeat radiographs in 6 months 8% (265/3129) 2 Bracing with a thoraco-lumbar-sacral orthosis 4% (120/3129) 3 Magnetic resonance imaging (MRI) 86% (2700/3129) 4 Posterior spinal fusion with instrumentation 1% (22/3129) 5 Anterior and posterior spinal fusion with instrumentation 0% (10/3129) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (SBQ06SN.19) An isolated long-segment instrumented posterior spinal fusion is considered in which of the following clinical situations? QID: 1704 Type & Select Correct Answer 1 A 13-year old female, Risser 3, with adolescent idiopathic scoliosis (AIS) and a Cobb angle of 55 degrees 79% (2049/2597) 2 A 5-year old male, with juvenile idiopathic scoliosis (JIS) and a Cobb angle of 55 degrees 6% (161/2597) 3 A 2-year old female with infantile idiopathic scoliosis (IIS), a flexible curve with a Cobb angle of 35°, and a RVAD of 25° 1% (34/2597) 4 A 7-year-old with a progressive spinal deformity. Imaging demonstrates a T9 failure of formation with contralateral segmentation failure 12% (306/2597) 5 A 13-year old female Risser 2, with AIS and a Cobb angle of 27 degrees 1% (37/2597) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ06.17) 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. QID: 28 Type & Select Correct Answer 1 Thoracic curve coronal correction of > 40% 5% (88/1781) 2 Thoracolumbar/lumbar curve coronal correction > 50% 24% (424/1781) 3 Smaller adolescents (<50 kg) 3% (59/1781) 4 Failure to maintain lumbar lordosis of > 45 degrees 14% (252/1781) 5 Thoracic hyperkyphosis (>40 degrees ) 53% (943/1781) L 4 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ06.35) 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: QID: 146 FIGURES: A Type & Select Correct Answer 1 difficulty with vaginal child birth in the future. 1% (19/2610) 2 decreased pulmonary function in the future 5% (120/2610) 3 to undergo an MRI to rule out any underlying neurologic pathology, as this is an abnormal curve 7% (190/2610) 4 an increased risk of chronic back pain over her lifetime 80% (2091/2610) 5 this curve magnitude has the highest curve progression rate without operative intervention 7% (174/2610) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ04.144) 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? QID: 1249 Type & Select Correct Answer 1 Acute and chronic back pain 71% (1615/2280) 2 Premature death 6% (137/2280) 3 Disability 8% (193/2280) 4 Clinical depression 3% (79/2280) 5 Limitation in activities of daily living 11% (247/2280) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic
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