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1. Scoliosis Andrea Chymiy Swedish Family Medicine September 24, 2002

12. Risk of Curve Progression *— Low risk = 5 to 15 percent; moderate risk = 15 to 40 percent; high risk = 40 to 70 percent; very high risk = 70 to 90 percent. Curve (degree) Growth potential ( Risser grade ) Risk 10 to 19 Limited (2 to 4) Low 10 to 19 High (0 to 1) Moderate 20 to 29 Limited (2 to 4) Low/mod 20 to 29 High (0 to 1) High >29 Limited (2 to 4) High >29 High (0 to 1) Very high .

21. Referral Guidelines & Treatment Curve (degrees) Risser grade X-ray/refer Treatment 10 to 19 0 to 1 Every 6 months/no Observe 10 to 19 2 to 4 Every 6 months/no Observe 20 to 29 0 to 1 Every 6 months/yes Brace after 25 degrees 20 to 29 2 to 4 Every 6 months/yes Observe or brace 29 to 40 0 to 1 Refer Brace 29 to 40 2 to 4 Refer Brace >40 0 to 4 Refer Surgery †

27. Case #1 MP is a 16-year-old male who presents to your office for his annual health assessment and sports physical. During the course of his examination, you note a mild convexity in the thoracic region of his spine with forward flexion at the hips. Based on your clinical examination, you estimate a lateral spinal curvature of about 5 degrees. You note these findings to the patient and then to his mother.

29. Answer 1 The answer is D: monitor the patient's condition.

30. Question 2 Because you have recently agreed to serve as school physician in the district where your office is located, you wonder what scoliosis screening programs are in place and who has been examining these school children for scoliosis. Which one of the following procedures should you implement ?

34. Answer 3 The answer is B: Although surgery for scoliosis is generally not recommended without marked curvature, well-conducted outcomes studies with patients who have had surgery have not been completed. Symptoms of back pain do not appear to correlate with magnitude of surgical correction.