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The 10-year-old boy shown in Figures A-B wishes to participate in junior football. A cervical spine CT scan is shown in Figure C. His renal evaluation shows unilateral renal aplasia and his cardiac evaluation is normal. What is his most likely diagnosis and the most appropriate corresponding medical clearance decision for playing football?
Klippel-Feil syndrome with no participation in contact sports
Down's syndrome with no participation in contact sports
Holt-Oram syndrome with no participation in contact sports
Down's syndrome with full participation in contact sports only following skeletal maturity
Klippel-Feil syndrome with full participation in contact sports only following skeletal maturity
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Klippel-Feil syndrome is defined as congenital cervical fusion of cervical vertebra characterized by a triad of a low, posterior hairline, a short neck, and limited neck motion. Klippel-Feil patients with cervical spine fusions above C3 should not participate in contact sports. It is critical that patients undergo a cardiac and renal evaluation upon their diagnosis to look for cardiac septal defects and several different types of renal anomalies.
Patients with congenital cervical fusion may be at an increased risk of sustaining a transient neurologic deficit after minor trauma. Illustration A and B show a radiograph and MRI of a Klippel-Feil patient sustaining a central cord syndrome following a fall during a sporting activity.
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