To whom should a 16-year-old patient with a new diagnosis of scoliosis be referred for further evaluation and treatment?

Referral for 16-Year-Old with New Scoliosis Diagnosis

A 16-year-old with newly diagnosed scoliosis should be referred to a pediatric orthopedic surgeon. 1, 2

Specialist Qualifications

A pediatric orthopedic surgeon is the appropriate specialist because they have completed:

• A full orthopedic surgery residency
• An additional ACGME-approved 1-year fellowship specifically in pediatric orthopedics 1, 2

This specialized training ensures expertise in managing spinal deformities in the adolescent population, including assessment of growth potential, curve progression risk, and treatment planning. 2

Why Pediatric Orthopedic Surgery

Infants, children, and adolescents with significant spinal deformity (scoliosis or kyphosis) are specifically identified as patients who should be managed by a pediatric orthopedic surgeon. 1, 2

At 16 years old, this patient falls within the adolescent category (13-18 years) defined in pediatric orthopedic referral guidelines. 1 The American Academy of Pediatrics explicitly lists scoliosis as a condition requiring pediatric orthopedic surgical expertise. 1, 2

Initial Imaging Before or With Referral

• Standing posteroanterior (PA) radiographs of the complete spine are the appropriate initial imaging for adolescents (10-18 years) with idiopathic scoliosis and no red flag features. 1, 2
• These radiographs allow measurement of the Cobb angle, which determines severity and guides treatment decisions. 3, 4

Red Flags Requiring Urgent Evaluation

The orthopedic surgeon will assess for atypical features that may indicate underlying pathology requiring MRI evaluation. These include: 1, 2

• Left thoracic curve (typical adolescent idiopathic scoliosis is right thoracic)
• Short segment curve (4-6 vertebral levels)
• Absence of normal apical lordosis (hyperkyphosis at curve apex)
• Rapid progression (>1° per month)
• Functionally disruptive pain (idiopathic scoliosis is typically painless)
• Focal neurological findings on examination
• Male sex (less common for adolescent idiopathic scoliosis)
• Pes cavus (high-arched feet)

Treatment Considerations by Curve Severity

The pediatric orthopedic surgeon will determine management based on: 4, 5, 6

• Observation: Curves <20° with high growth potential (Risser 0-2) or curves <40° with minimal growth potential (Risser 3-5) 5
• Bracing: Curves 20-40° in patients with significant remaining growth 5, 6
• Surgery: Generally indicated for curves >40-50° or progressive curves despite bracing 7, 2, 5, 6

At 16 years old, skeletal maturity assessment (Risser staging) is critical because it determines progression risk and treatment urgency. 3, 5

Timing of Referral

Referral should occur promptly because:

• Curves >20° in patients ≥10 years old warrant specialist evaluation 4
• Early detection allows for bracing intervention if appropriate, which can prevent progression to surgical thresholds 3, 8
• At 16 years, the patient may still have growth potential depending on skeletal maturity, making timely assessment essential 5

Common Pitfalls to Avoid

• Do not delay referral waiting to see if the curve progresses—the orthopedic surgeon should establish baseline measurements and monitoring intervals 2, 3
• Do not refer to adult orthopedic surgeons—pediatric-specific training is important for growth assessment and age-appropriate treatment planning 1, 2
• Do not obtain MRI routinely—this is only indicated for atypical features or red flags and should be determined by the specialist 1, 2