Daily answer

[Scott Rand]

A 14-year-old female presents for a pre-sports physical. She complains of back discomfort when she "sits at school for a long time." Her exam reveals scoliosis with a left-sided curve. An MRI of the spine is indicated to rule out which of the following conditions?

 

A.     Intraspinal syrinx

B.      Narrowing of disk space

C.      Schmorl nodes

D.     Irregularities in vertebral endplates

E.      Loss of anterior vertebral height

 Correct answer: (A) Intraspinal syrinx.

Explanation: About 80% of scoliosis cases appear as a right thoracic curve. A left-sided pattern is associated with risk for intraspinal syrinx or tumor, which can be detected on MRI. The remainder of findings are associated with Schneurmann kyphosis, the 2nd-most common cause of spinal deformities in pediatrics. A scoliotic curve must measure greater than or equal to 10 degrees on a spinal radiograph via the Cobb method (a special tool that measures the angle on radiograph) to meet the criteria for diagnosing scoliosis, but most patients do not exhibit clinically significant respiratory symptoms until the curves measure 60 to 100 degrees.

The USPSTF states that treating idiopathic scoliosis during adolescence leads to health benefits in only a small fraction of patients. Most of the cases detected through screening do not become clinically significant, and scoliosis that requires aggressive treatment/operative treatment is likely to be detected without screening because these patients are eventually symptomatic.

 

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Scott E Rand, MD  FAAFP CAQSM

Director, Primary Care Sports Medicine Fellowship

Co Director of Sports Medicine, Houston Methodist Orthopedics and Sports Medicine Willowbrook

Assistant Professor of Clinical Family Medicine  Houston Methodist Academic Institute

Adjunct Assistant Professor of Family and Community Medicine, Texas A&M University

Assistant Professor of Family Medicine in Clinical Medicine  Weill Cornell Medical College.

13802 Centerfield Dr  Suite 300

Houston, TX  77070