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Adolescent Idiopathic Scoliosis

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 13-year-old girl is referred by her school nurse with a positive forward bend test. She had menarche 6 months ago. Her mother noticed asymmetry in her waist and shoulders. She has no back pain, no neurological symptoms, and no family history of scoliosis. On examination, she has a right thoracic prominence on forward bending and her shoulders and pelvis appear level.
Standing PA radiograph demonstrating a right thoracic curve measuring 52 degrees (Cobb angle) from T5-T12 in a skeletally immature female (Risser 2). There is thoracic hypokyphosis. The curve is structural with >25 degrees on bending films. Lateral view shows thoracic hypokyphosis. This represents adolescent idiopathic scoliosis (AIS) with a large curve requiring surgical discussion.
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Standing PA radiograph demonstrating a right thoracic curve measuring 52 degrees (Cobb angle) from T5-T12 in a skeletally immature female (Risser 2). There is thoracic hypokyphosis. The curve is structural with >25 degrees on bending films. Lateral view shows thoracic hypokyphosis. This represents adolescent idiopathic scoliosis (AIS) with a large curve requiring surgical discussion.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the radiographic findings and how do you measure and classify this curve?

Question 2 (5 marks)

What clinical examination findings are important and what red flags suggest non-idiopathic scoliosis?

Question 3 (6 marks)

What are the treatment options and what determines the choice?

Question 4 (5 marks)

Describe the Lenke classification and how it guides surgical planning.

Question 5 (4 marks)

What is your surgical technique for posterior spinal fusion?

Question 6 (4 marks)

What are the expected outcomes and potential complications?

Exam Day Cheat Sheet

Must Mention

  • •Cobb angle measurement
  • •Risser grade for maturity (0-5)
  • •Brace: 25-40°, immature (Risser 0-2)
  • •Surgery: >45-50° immature, >50° any maturity
  • •BrAIST: 72% success with bracing
  • •Lenke classification: type + lumbar + sagittal modifier
  • •Left thoracic = MRI for syrinx
  • •Neuromonitoring essential

Common Pitfalls

  • •Not measuring Cobb angle
  • •Wrong Risser staging
  • •Bracing mature patient
  • •Missing MRI indications
  • •Not knowing Lenke
  • •Forgetting neuromonitoring