Spine: surgery for adolescent idiopathic scoliosis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: surgery for adolescent idiopathic scoliosis

Sample item

A 13-year-old girl, Risser grade 2, has a right thoracic curve that has progressed to a Cobb angle of 55 degrees despite bracing. What is the most appropriate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Posterior spinal fusion with instrumentation

Curves well over 45 to 50 degrees in a growing child tend to progress even after maturity and impair cardiopulmonary function, so surgical correction by posterior instrumented fusion is indicated. Bracing is meant for curves between about 25 and 40 degrees in a growing child to halt progression and does not correct a large curve.

Option by option

  • A. Schroth exercises alone

    Exercise programmes may supplement bracing but cannot treat a curve of 55 degrees.

  • B. Observation until skeletal maturity

    Observation would allow a curve of this magnitude to keep progressing.

  • C. Continued bracing with serial radiographs

    Bracing has failed here and is not effective for a curve of this size.

  • D. Posterior spinal fusion with instrumentation (correct)

    Correct. A progressive curve of 55 degrees in a growing adolescent needs posterior instrumented fusion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Posterior spinal fusion with instrumentation. Curves well over 45 to 50 degrees in a growing child tend to progress even after maturity and impair cardiopulmonary function, so surgical correction by posterior instrumented fusion is indicated.

Why is "Schroth exercises alone" not the answer?

Exercise programmes may supplement bracing but cannot treat a curve of 55 degrees.

Why is "Observation until skeletal maturity" not the answer?

Observation would allow a curve of this magnitude to keep progressing.

Why is "Continued bracing with serial radiographs" not the answer?

Bracing has failed here and is not effective for a curve of this size.

What concept does this question test?

It tests Spine: surgery for adolescent idiopathic scoliosis in Orthopaedics. Bracing is meant for curves between about 25 and 40 degrees in a growing child to halt progression and does not correct a large curve.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: surgery for adolescent idiopathic scoliosis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.