A 13-year-old girl is brought to the office by her mother for a preparticipation sports physical. She is planning to play lacrosse, which she had played the previous school year. The coach notified the mother that the girl's posture seemed abnormal. The patient has no chronic medical conditions and takes no daily medications. She has not undergone menarche. BMI is at the 50th percentile. Physical examination shows a right-sided lumbar prominence during forward bend test, and there is no tenderness of the spine. The remainder of the examination reveals no abnormalities with normal neurologic function. Which of the following is the best next step in the management of this patient?

Question

A 13-year-old girl is brought to the office by her mother for a preparticipation sports physical.  She is planning to play lacrosse, which she had played the previous school year.  The coach notified the mother that the girl's posture seemed abnormal.  The patient has no chronic medical conditions and takes no daily medications.  She has not undergone menarche.  BMI is at the 50th percentile.  Physical examination shows a right-sided lumbar prominence during forward bend test, and there is no tenderness of the spine.  The remainder of the examination reveals no abnormalities with normal neurologic function.  Which of the following is the best next step in the management of this patient?

Quizplus · Accepted Answer

11ec25c8_d60d_acf1_bc81_957594bc5085_MD0003_00 Adolescent idiopathic scoliosis (AIS) refers to lateral curvature (ie, Cobb angle >10 degrees) of the spine without a specified etiology. The deformity typically presents in children age ≥10 during periods of rapid growth. Although poor posture may be noted, AIS is usually asymptomatic and identified during school scoliosis screening or annual physical examination. Inspection of the back may reveal asymmetry of the shoulders, scapulae, or iliac crest. Forward bend test shows asymmetric thoracic or lumbar prominence. Forward bend test The first step in evaluating clinically evident spinal asymmetry is x-ray of the spine. Full-back posteroanterior and lateral radiographs confirm the diagnosis, measure the severity of disease (ie, Cobb angle), and assess skeletal maturity. x-ray Cobb angle Management of AIS depends on risk of progression (eg, degree of skeletal maturity) and severity (ie, degree of curvature on x-ray). Scoliosis typically progresses slower with increasing degrees of bone ossification. Therefore, patients are at increased risk for progression in early puberty (eg, premenarche). Most curves are mild (ie, Cobb angle 10-30 degrees) and can be monitored clinically every 6 months (Choice B). A thoracolumbosacral spinal brace is indicated in a child with growth potential remaining and Cobb angle ≥30 degrees to help reduce curve progression (Choice D). Surgical fixation is considered for severe curvature (ie, Cobb angle ≥40-50 degrees) (Choice C). thoracolumbosacral spinal brace (Choice A) Scoliosis due to pathologic causes (eg, mass, dysraphism) may present with neurologic symptoms, severe pain, rapid progression, or vertebral abnormalities on x-ray. MRI of the spine should be performed in such cases but is not indicated in this asymptomatic patient. Educational objective: Adolescent idiopathic scoliosis is defined as lateral curvature of the spine without a known etiology in a child age ≥10. Forward bend test reveals an asymmetric thoracic or lumbar prominence. The first step in evaluation is x-ray of the spine to determine the degree of curvature and assess skeletal maturity. References: Adolescent idiopathic scoliosis: diagnosis and management. (http://www.ncbi.nlm.nih.gov/pubmed/24506121)

A 13-Year-Old Girl Is Brought to the Office by Her