Is a 22-year-old male with mild thoracic dextroscoliosis (22° Cobb), mild lumbar levoscoliosis (5° Cobb), right hemipelvic tilt of ~6 mm, Risser grade 5 and no pain or neurologic deficits medically cleared for unrestricted occupational, academic, and recreational activities?

Medical Clearance for 22-Year-Old Male with Mild Scoliosis

This patient is medically cleared for unrestricted occupational, academic, and recreational activities. His thoracic curve of 22° and lumbar curve of 5° fall well below surgical thresholds, and his Risser grade 5 indicates complete skeletal maturity, eliminating progression risk associated with growth. 1, 2

Rationale for Clearance

Curve Severity Assessment

• The thoracic dextroscoliosis of 22° is below all intervention thresholds. Bracing is considered for curves 20-26° only in skeletally immature patients with progression risk, and surgical intervention is reserved for curves exceeding 40-50°. 1, 2
• The lumbar levoscoliosis of 5° is clinically insignificant, falling well below the 10° diagnostic threshold for scoliosis and requiring no monitoring or treatment. 3
• Skeletally mature patients with curves under 30° have minimal progression risk. After skeletal maturity, only curves exceeding 30° require ongoing monitoring for progression. 4

Skeletal Maturity Status

• Risser grade 5 confirms complete skeletal maturity with full ossification and fusion of iliac crest apophyses, eliminating the primary driver of curve progression. 1, 2
• The progression risk in skeletally immature patients with curves >20° exceeds 70%, but this patient's skeletal maturity negates this concern entirely. 1, 3
• Thoracic curves >50° may progress at approximately 1° per year after skeletal maturity, but this patient's 22° curve is far below this threshold and unlikely to reach problematic magnitudes even with slow progression. 2

Monitoring Recommendations

• No routine follow-up imaging is required. The American College of Radiology recommends radiographs every 18 months for Risser stages 4-5 with curves <20°, but this applies to monitoring during the transition to skeletal maturity. 1
• This patient requires clinical follow-up only if new symptoms develop, such as progressive back pain, neurological symptoms, or functional limitations. 1, 2

Occupational and Activity Considerations

• No activity restrictions are warranted. The mild curve magnitude and skeletal maturity pose no contraindication to physical labor, contact sports, or any occupational demands. 1, 2
• The 6 mm pelvic tilt is minimal and does not require intervention unless associated with symptomatic leg length discrepancy or hip pathology, which are not reported here. 5

Common Pitfalls to Avoid

• Do not assume progression will occur simply because a curve exists. In skeletally mature patients with curves <30°, progression is uncommon and slow if it occurs at all. 4
• Do not order unnecessary surveillance imaging. This patient's curve magnitude and skeletal maturity do not justify routine radiographic monitoring, which would expose him to cumulative radiation without clinical benefit. 1, 2
• Do not restrict activities based on curve presence alone. Functional limitations should drive activity modifications, not radiographic findings in asymptomatic patients. 1, 2