Adolescent Idiopathic Scoliosis

Authors:

Jose Ting, BS; Jacqueline Furbacher, BS; Fatima Aly, MD; and Lynnette Mazur, MD, MPH
McGovern Medical School at the University of Texas Health Science Center at Houston

Citation:

Ting J, Furbacher J, Aly F, Mazur L. Adolescent idiopathic scoliosis [published online January 4, 2018]. Consultant360.

A 12-year-old girl presented for evaluation of scoliosis. Over the past year, her family had noticed that the curvature of her spine had worsened. The patient reported lower back pain, particularly in the mornings, but denied exercise intolerance; she described herself as sedentary and rarely exercised. Menarche had begun 6 months ago. Her family history was negative for scoliosis.

Physical examination. On physical examination, the patient’s height was 158.7 cm (50th-75th percentile) and her weight was 40.7 kg (25th-50th percentile), equaling a body mass index (BMI) of 17 kg/m2 (28th percentile). Examination of her back showed elevation of the right shoulder, scapular prominence, asymmetric flank creases, spacing between the trunk and arm, elevation of the right hip, and a right-sided thoracic curvature. Results of the Adams forward bend test were positive for scoliosis (Figures 1 and 2). No pectus, heart murmur, or café au lait macules were noted, and she was at Tanner stage 4.

scoliosis figure 1
Figure 1. Posterior view of patient.

scoliosis figure 2
Figure 2. Adams forward bend test.

Diagnostic tests. The initial radiograph of the spine showed a right-sided thoracic curve and a left-sided lumbar curve measuring 46° and 51°, respectively (Figure 3). Repeated imaging 4 months later showed progression to 56° and 57°, respectively. A genetic consult ruled out Marfan syndrome (Ghent score, 1) and Ehlers-Danlos syndrome (Beighton hypermobility score, 3). No mitral valve prolapse or aortic root dilation were noted on the echocardiogram. The patient received a diagnosis of adolescent idiopathic scoliosis and underwent a posterior spinal fusion with instrumentation.

scoliosis figure 3
Figure 3. Posteroanterior radiograph of the spine.

Next: Discussion and Outcome of the Case

Authors:

Jose Ting, BS; Jacqueline Furbacher, BS; Fatima Aly, MD; and Lynnette Mazur, MD, MPH
McGovern Medical School at the University of Texas Health Science Center at Houston

Citation:

Ting J, Furbacher J, Aly F, Mazur L. Adolescent idiopathic scoliosis [published online January 4, 2018]. Consultant360.

A 12-year-old girl presented for evaluation of scoliosis. Over the past year, her family had noticed that the curvature of her spine had worsened. The patient reported lower back pain, particularly in the mornings, but denied exercise intolerance; she described herself as sedentary and rarely exercised. Menarche had begun 6 months ago. Her family history was negative for scoliosis.

Physical examination. On physical examination, the patient’s height was 158.7 cm (50th-75th percentile) and her weight was 40.7 kg (25th-50th percentile), equaling a body mass index (BMI) of 17 kg/m2 (28th percentile). Examination of her back showed elevation of the right shoulder, scapular prominence, asymmetric flank creases, spacing between the trunk and arm, elevation of the right hip, and a right-sided thoracic curvature. Results of the Adams forward bend test were positive for scoliosis (Figures 1 and 2). No pectus, heart murmur, or café au lait macules were noted, and she was at Tanner stage 4.

scoliosis figure 1
Figure 1. Posterior view of patient.

scoliosis figure 2
Figure 2. Adams forward bend test.

Diagnostic tests. The initial radiograph of the spine showed a right-sided thoracic curve and a left-sided lumbar curve measuring 46° and 51°, respectively (Figure 3). Repeated imaging 4 months later showed progression to 56° and 57°, respectively. A genetic consult ruled out Marfan syndrome (Ghent score, 1) and Ehlers-Danlos syndrome (Beighton hypermobility score, 3). No mitral valve prolapse or aortic root dilation were noted on the echocardiogram. The patient received a diagnosis of adolescent idiopathic scoliosis and underwent a posterior spinal fusion with instrumentation.

scoliosis figure 3
Figure 3. Posteroanterior radiograph of the spine.

Next: Discussion and Outcome of the Case