Module 24, Pediatric Orthopaedist Level

1,2

A 10 year old female presented with a spinal curvature which was first noted in a routine camp physical. She had no neurologic complaints. Her birth, medical, and developmental history were all unremarkable. Her family history was negative except there was a vague history of spinal curvature in the father. Physical examination was significant for a moderate left thoracic rib prominence, normal lower extremity reflexes, sensation and strength, but an absent abdominal reflexes in the upper and lower quadrants on the left side. A 24 degree left thoracic curve from T5 - Tl1 was measured (image 1). Also noted was an Arnold-Chiari malformation (image 2).

Question 24A

The correct definitive treatment for this girl is occiput decompression and drainage of the cyst.

Question 24B

Decompression of this lesion is indicated because this will probably prevent the scoliosis from progressing.

Question 24C

The presence of syringomyelia and scoliosis should raise the concern about the possibility of an occult spinal cord tumor.

Question 24D

A syrinx should be suspected in a child if the spinal canal on AP x-ray at C5 is wider than the body of C6.

Question 24E

Most syrinx are located in the dorsal aspect of the spinal cord which means they primarily and initially affect the trunk muscles.