Module 9, Pediatric Orthopaedist Level
A 14 month old child was brought for evaluation because of low posterior
hair line, short neck and limited neck ROM. He was the product of a normal
pregnancy and delivery. Mother was also concerned because he holds his
head to one side. Physical examination demonstrated an elevated shoulder
on the right and very limited side bending of the neck to either side although
he held his head slightly cocked to the left. An x-ray was obtained which
demonstrated a complex posterior fusion mass and an elevated scapula on
the right. At age 12, the boy was noted to have a 35 degree high thoracic
scoliosis and x-rays which showed motion at the cervico-occipital junction
and one open disc at the mid to low cervical spine. Complex fusion masses
were noted above and below this segment.
Question 9A
This
scoliosis is of little concern since it is high and only 35 degrees.
Question 9B
The
open segment should be fused now, to prevent future problems.
Question 9C
The
C1 occiput needs to be closely monitored because this area also can become
unstable.
Question 9D
The
boy wants you to sign a paper for him to play football which you do, but
suggest that he has to wear a neck collar during practice and play.
Question 9E
On
clinical examination you find an asymmetric abdominal reflex. This has
little meaning in patients with congenital deformities.
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