From the Guidelines
The most appropriate next step for this 13-year-old girl with a positive Adams forward bend test is thoracic imaging to assess curvature of the spine, specifically to measure the Cobb angle and determine the severity of the spinal curvature. The positive Adams test suggests scoliosis, which is characterized by an abnormal lateral curvature of the spine 1. Radiographic imaging, typically standing posteroanterior and lateral spine X-rays, is the initial imaging modality of choice for evaluating suspected scoliosis in adolescents 1. This is essential for establishing appropriate management, which ranges from observation for mild curves to bracing or surgical intervention for more severe cases. Adolescent idiopathic scoliosis is most common in girls during periods of rapid growth, making this 13-year-old patient a typical presentation 1. Early detection and intervention are important as progression of the curve is more likely during growth spurts, and severe untreated scoliosis can lead to physical deformity, pain, and potential cardiopulmonary complications in adulthood.
Some key points to consider in the evaluation and management of scoliosis include:
- The Cobb angle, as determined on radiographs, plays a key role in the surgical decision-making process 1
- Serial PA spine radiographs are an integral part of the follow-up of these patients, with the frequency of imaging depending on the patient's skeletal maturity and curve severity 1
- MRI may be considered in certain cases, such as when there are neurologic abnormalities or suspected underlying conditions, but it is not typically the initial imaging modality of choice for evaluating suspected scoliosis in adolescents 1
Overall, the primary goal of thoracic imaging in this patient is to assess the curvature of the spine and determine the severity of the spinal curvature, which will guide further management and treatment. Thoracic imaging to assess curvature of the spine is the most appropriate next step in the evaluation and management of this patient.
From the Research
Osseous Abnormalities to Assess
In a 13-year-old girl with a positive Adams Forward Bend Test result, thoracic imaging should assess for curvature of the spine, specifically:
- Scoliosis, which is a lateral curvature of the spine
- Kyphosis, which is an excessive outward curve of the spine, leading to an abnormal rounding of the back
- Lordosis, which is an excessive inward curve of the spine
Imaging Modalities
The following imaging modalities can be used to assess these osseous abnormalities:
- X-ray, which is the gold standard for diagnosing and monitoring scoliosis 2, 3
- MRI, which can be used to measure sagittal Cobb angles in scoliosis 3
- Ultrasound, which is a non-invasive and radiation-free modality that can be used to measure curvature angles in scoliosis 4, 5
- CT scans, which can be used to assess vertebral rotation and thoracic torsion in scoliosis 6
Measurement Techniques
The following measurement techniques can be used to assess osseous abnormalities:
- Cobb method, which is a widely used technique for measuring the degree of curvature in scoliosis 2, 4
- ZEBRIS spine examination method, which is a non-invasive technique that uses an ultrasound-based motion analysis system to measure spinal curvature angles 2
- Spinal Mouse (SM) assessment, which is a safe and practical method for measuring curvature in scoliosis 4
- Ultrasound curve angle (UCA) measurement, which is a technique that uses ultrasound imaging to measure curvature angles in scoliosis 5