Module 28, General Orthopaedist Level

The patient is a 4 year old male who developed an insidious onset of neck pain and stiffness 4 days prior to admission. Over the intervening period, the patient suffered from worsening of his symptoms which led to increasing irritability and difficulty sleeping. On the day of admission, he developed severe neck pain. It was observed that his head was in a fixed position just slightly right of midline. The patient's past medical history was remarkable for two recent self-limited episodes of hives and urticaria on his trunk and extremities that was treated with prednisone. There was vague history of remote trauma about one month previously when the patient had been "horsing" around with his brother. The child had no evidence of a viral prodrome, constitutional symptoms or travel history.

Question 28A

The next stage in the work up should be to obtain an MRI scan.

Question 28B

A biopsy of the calcified disc is indicated to rule out an infectious etiology.

Question 28C

Calcification of the intervertebral discs occur most commonly in the cervical area in children.

Question 28D

Hyperparathyroidism and hemochromatosis have been implicated as associated with disc calcification, therefore a work up of these conditions is indicated.

Question 28E

On further work up this child developed a fever of 39 and had a WBC of 14,400. Therefore further work up for an infectious source is indicated.