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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
Figures 31a and 31b show the radiograph and MRI scan of an otherwise normal 3-month-old infant who has a spinal deformity. MRI reveals no intraspinal anomalies. What is the next step in management?
Posterior spinal fusion with instrumentation
Cardiac and renal evaluation
Hemivertebrectomy and fusion
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A 4-month-old infant is referred for evaluation of congenital scoliosis. The child has no congenital heart anomalies, and a renal ultrasound shows that he has one kidney. Examination reveals mild scoliosis and a large hairy patch on the child’s back. Neurologic evaluation is normal for his age. A clinical photograph and radiograph are shown in Figures 19a and 19b. Initial management should consist of
referral to a plastic surgeon to remove the hairy patch.
MRI of the entire spine.
physical therapy and repeat evaluation and radiographs in 1 year.
anterior and posterior fusion of the anomalous regions of the spine to prevent deformity.
The parents of a 14-month-old boy bring their child into your office. They state the child has reached developmental milestones at appropriate ages, but noticed he was leaning to one side when standing or walking. A radiograph was obtained demonstrating a non-flexible 40-degree curve with multiple vertebral anomalies, highlighted by a convex segmented hemivertebra associated with a concave unilateral bar. After ensuring that the patient has no other associated anomalies in other organ systems, an MRI of the spine revealed no intraspinal abnormalities. What treatment would you recommend to the family?
Continued observation with annual follow up
Instrumentation with growing rods without fusion
Excision of the hemivertebra with short segment posterior instrumented fusion
Figure A demonstates different anatomic patterns in congenital scoliosis. Which pattern has the worst prognosis and is an indication for surgery.
A 2-year-old girl presents to the office for evaluation of spinal deformity. A radiograph is shown in Figure A. What additional work-up should be done?
Bone scan with SPECT images