1. Imaging Findings

Based on the provided thoracic spine (AP and lateral) X-ray images, the following observations are noted:

• An obvious scoliosis (S-shaped curvature) and thoracic kyphotic deformity (hunchback) can be seen, suggesting a significant imbalance in the thoracic and lumbar spine.
• The vertebral sequence is misaligned, with thoracic and/or lumbar vertebrae deviating to one side, accompanied by partial vertebral rotation. These findings are consistent with scoliosis/kyphosis.
• Local chest wall deformity may lead to changes in the thoracic cavity, potentially affecting chest volume. Some patients may experience chest pain, difficulty breathing, and other symptoms.

2. Potential Diagnoses

Considering the patient’s 5-year history of chest pain, childhood onset of chest wall deformity, and the X-ray findings indicative of thoracic scoliosis and kyphosis, the following diagnoses are primarily considered:

1. Idiopathic Scoliosis
   Characteristics: Often appears during the growth period. Some patients may only show marked symptoms in adulthood. Radiographic findings may reveal scoliosis with varying degrees of rotation or kyphosis.
2. Congenital Scoliosis
   Characteristics: Caused by congenital malformations of the vertebrae. It usually presents with chest wall deformity from childhood, and kyphosis or scoliosis may result in visible deformities that progress with age.
3. Degenerative Scoliosis
   Characteristics: More common in middle-aged and older adults, resulting from degenerative disc disease causing spinal instability and curvature. Although the patient is 47 years old, a long-standing condition may still be considered.

3. Final Diagnosis

Considering the existence of chest wall deformities since childhood, the current obvious chest pain, and X-ray evidence of significant thoracic scoliosis and kyphotic deformities, a preliminary diagnosis of “Kyphoscoliosis” can be made. Given the long history and prominent deformity, it may stem from congenital or adolescent idiopathic scoliosis continuously progressing over time.

To further clarify any congenital structural abnormalities, vertebral pathologies, and assess the feasibility of surgical intervention, it is recommended to conduct further CT or MRI examinations. Bone density tests and other relevant evaluations may also be needed.

4. Treatment Plan and Rehabilitation Program

4.1 Treatment Strategy Overview

• Conservative Treatment: For mild to moderate deformities or symptoms that are still tolerable, methods such as physical therapy, muscle training, pain medications, and bracing (if some degree of correction is still possible) can be used to reduce symptoms.
• Surgical Treatment: If the deformity is severe, the patient’s chest pain is pronounced and affects daily activities, or if there is compromised cardiopulmonary function, corrective surgery may be considered. Surgical indications mainly depend on the Cobb angle of scoliosis, the kyphotic angle, and the severity of symptoms.
• Medication: Pain relievers or muscle relaxants may be given as needed to alleviate painful spasms.

4.2 Rehabilitation and Exercise Prescription

The goal of rehabilitation is to maintain/improve spinal flexibility, balance muscle strength, reduce pain, and help improve cardiopulmonary function. The program should be individually tailored based on the patient’s current fitness level and extent of pathology, and should follow a gradual progression. The FITT-VP principle is recommended:

1. Type of Exercise (Type):
   • Postural correction training: Includes training for standing, sitting, and walking posture.
   • Core muscle strengthening: Focus on the transverse abdominis, multifidus, pelvic floor muscles, and other core stability exercises.
   • Stretching exercises: Moderate stretching of the back, chest, and shoulder-neck muscle groups to relieve tension caused by poor posture.
   • Cardiopulmonary exercise: Low-intensity aerobic activities (such as brisk walking, swimming, or stationary cycling) that help maintain cardiopulmonary health without causing excessive fatigue.
2. Frequency (Frequency):
   3-5 sessions per week, adjusted according to the patient’s daily schedule and pain tolerance. Start at a lower frequency and increase progressively.
3. Intensity (Intensity):
   Begin with low to moderate intensity, using heart rate, breathing pattern, and subjective fatigue as indicators, and gradually increase. If significant chest pain or discomfort occurs, reduce or pause activity promptly.
4. Time (Time):
   20-30 minutes per session initially, gradually increasing to 45 minutes or longer as fitness improves.
5. Mode (Mode):
   Prioritize low-impact activities that make it easy to monitor heart rate and posture. Avoid high-impact or twisting movements. Examples include elliptical training and aquatic exercises (such as swimming or water aerobics), which place less stress on the spine.
6. Progression (Progression):
   Once the patient can comfortably handle the current intensity and duration, gradually increase the difficulty and load of the exercise program. This can include more advanced core stability exercises and moderate weight-bearing training.

Special Note: Since the patient has spinal deformity and potential cardiopulmonary involvement, respiratory status should be closely monitored during rehabilitation exercises. If significant chest tightness, shortness of breath, or worsened spinal pain occurs, the program should be adjusted promptly.

Disclaimer

This report is based on available information for reference and does not replace in-person consultation and professional medical advice. If you have any questions or if symptoms worsen, please seek prompt medical attention or consult specialists in orthopedics and rehabilitation medicine.