spine
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.
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