Question of the week # 303

303) A 11 year old girl is evaluated in your office for progressing lateral curvature of her spine. She denies any back pain or neurological symptoms. Her mother is very concerned about the child’s appearance.  On physical examination, there is gross convexity in the thoracic region of her spine with forward flexion at the hips. There is no tenderness or neurological deficits. An x-ray of the spine reveals 25º curvature ( cob angle) . Which of the following is the most appropriate management at this time?

A) Repeat Clinical exam and x-rays at 6 months

B) Refer to orthopedic evaluation

C) Bracing

D) Spinal fusion surgery

E) Recommend back strengthening exercises

4 Responses

  1. a,,, repeat xr….

  2. c

  3. c

  4. C……The majority of cases of scoliosis do not require treatment.

    •If the curve is less than 25°, no treatment is required, and the child can be reexamined every four to six months.

    •If the curve is more then 25° but less than 30°, a back brace may be used for treatment.

    •Curves more than 45° will need to be evaluated for the possibility of surgical correction. Surgical correction involves fusing vertebrae together to correct the curvature and may require inserting rods next to the spine to reinforce the surgery.

    •Treatment options depend more on how likely it is that the curve will worsen than on the angle of the curve itself. A child with a 20° curve and four more years of growth may require treatment while a child with 29° of curvature who has stopped growing may not require treatment.

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