The patient reported that she was experiencing lower back pain most days measuring 7-8/10 on a visual analog scale (VAS). The patient’s medical history, family history, and systems review were unremarkable.
The physical examination revealed a prominent curvature in the spine, waist curve asymmetry, scapula malpositioning and significant right coronal imbalance (Figure 1 [Left]). Rib humping was apparent during the Adams forward bend test. The patient’s lower back pain was reproduced when the Kemps test was performed in the lumbar spine on the right.
No abnormalities were detected during the neurological examination.
X-rays taken at the time of the initial consultation demonstrated that the patient had a 44° (Cobb) left thoracic scoliosis with an apex at T10-11 intervertebral disc (Figure 1 [Right]). The patient was Risser 5 at the time of the initial consultation.
A modified type of bending x-ray was used to assess the patients curve flexibility. To perform this assessment the patient is taught how to perform an active self-correction. In this position, the patient is then x-rayed to determine the potential for a correction. As can be seen in (Figure 2) the patient’s curve shows good flexibility reducing to 23° in the active self-corrected position.
The patient reported that she had also consulted with an orthopedic surgeon. The surgeon had performed a physical examination and ordered an MRI. Aside from thoracic scoliosis, there were no other abnormalities detected on the MRI. The surgeon had advised the patient that, given her age and the magnitude of the curve, surgery was the most suitable treatment option for her scoliosis.