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 A 13-year-old Caucasian male is brought to your office by his mother, who says that the boy has 'a round back'. She is concerned that permanent deformity can result. He has no present complaints. His past medical history is insignificant. He does not smoke or consume alcohol. He denies any recreational drug use. He is physically active and plays soccer in the local team. He denies any significant trauma. Physical examination shows a postural round back that is corrected by voluntary hyperextension. Forward bending reveals no lateral deformity and no angulation. Neurological examination of the lower extremities is normal. You order x-ray of the spine that shows a convex alignment of the thoracic spine at 35 degrees. Which of the following is the best response concerning this patient's condition?1. It is a common finding in adolescents and usually has no adverse physical effects.
2. It is idiopathic scoliosis and needs orthopedic referral.
3. It is structural kyphosis and requires using braces and special exercises.
4. It is spondylolisthesis and most probably needs surgical correction.
5. Re-evaluation and some imaging studies are necessary in 3 months.

5.

5.

3,

1..

The patient returns nine months after the initial consultation and complains of occasional aching spinal pain in the thoracic region. The pain is brought on by physical activities and prolonged standing. The pain is relieved by over-the-counter acetaminophen or ibuprofen. He continues his usual physical activities, although he has experienced some difficulties at school, and his academic standing has deteriorated a little. He now smokes and consumes alcohol occasionally. He denies any recreational drug use. He has been sexually active with two partners over the last several months and used condoms for contraception. Physical examination reveals thoracic curving of the spine that is not corrected with voluntary hyperextension of the spine. On forward bending, sharp angularity is observed in the thoracic region, but no lateral deformity is present. Neurological examination of the lower extremities is normal. X-ray of the spine shows a convex alignment of the thoracic spine at 55 degrees. Which of the following is the best next step in the management of this patient?

Options

1. Immediate referral to a surgeon for correction of spondylolisthesis
2. Order bone scan to search for bone metastases
3. Orthopedic referral to correct significant scoliosis
4. Use bracing and exercises to strengthen spinal muscles
5. Reassure and recommend ibuprofen for pain relief

1-1
3-4

2nd ---my answer is 3 3. Orthopedic referral to correct significant scoliosis

I change my answer. If the curve is more than 20 degree, it needs braces and if it more than 45 degree, it needs surgery. So:

1 is 2
2 is 1


what are the answers?

4. Use bracing and exercises to strengthen spinal muscles
The typical treatment for structural kyphosis that is not severe (less than 70-80 degrees) includes the use of a Milwaukee brace.