Module 26, Pediatric Orthopaedist Level

This male child initially presented at age 3 with multiple cafe-au-lait spots larger than 1.5 cm and nodules especially on the left flank. At the age of eleven years old he presented with a complaint of thoracic back pain (1991) after two years of observation of a thoracic scoliosis. At his first visit the patient was diagnosed with a kyphoscoliosis that measured 62 degrees of a right thoracic T3-T7 curve and a 62 degree thoracic kyphosis.

Question 26A

The posterior spine fusion should be done now but limited to T3 to T7 which is the length of the curve.

Question 26B

Because of his young age, an anterior fusion should also be done.

Question 26C

Stable posterior instrumentation should be inserted to enhance curve correction and improve chance of union.

Question 26D

If an anterior fusion is performed the kyphotic element should be bridged with a strut graft.

Question 26E

Some children with neurofibromatosis develop scoliosis which resembles idiopathic scoliosis with equal right and left thoracic curves. In these patients there are no bone changes and no evidence of neurofibroma.

Go to Next Question Module, Go to General Orthopaedist Level Modules, Go to Question Module Home Page, Go to Case Presentation Home Page, Orthopaedic Department Home Page.