Module 70, Pediatric Orthopaedist Level

1,2,3,4

This 7 year old male presented to the cerebral palsy clinic with mild development delay, hyperactivity, and kyphosis. On physical examination he was slightly small for age (5th percentile weight for age, 10th percentile height for age) and had hyperactivity. He had no clonus or spasticity but a slightly clumsy gait. An MRI and plain x-rays were ordered (image 1, 2 & 3). After two years of brace wear the kyphosis increased to 78 degrees(image 4). The child is complaining of the brace and starting to refuse brace wear.

Question 70A

A change in treatment is indicated because the curve is increasing and switching to a body cast would be the next stage.

Question 70B

If surgery is to be considered an anterior release and posterior fusion would be required.

Question 70C

These mass appear to be meningoceles without neurofibroma.

Question 70D

Shunting of these meningoceles should be considered.

Question 70E

The fusion and instrumentation of the kyphosis should extend to T12.