Ojirese O. Momoh, DO
Physician
Mercy Hospital
New York, New York, United States
Thomas Moss, DO
Physician
Mercy Hospital
Rockville Centre, New York, United States
Kevin Paul, DO
Physician
Mercy Hospital
Rockville Centre, New York, United States
Dave Phillips, MD
Neurosurgeon
Mercy Hospital
Rockville Centre, New York, United States
Anjalee Dhanraj, n/a
Student
Mercy Hospital
Rockville Centre, New York, United States
An 11-year-old male patient with no significant medical history presented to pre performance evaluation for Fall sports. Patient underwent routine scoliosis screening as part of evaluation and was found to have an increased lateral curvature of the spine. Denied symptoms of back pain, gait abnormality or musculoskeletal weakness. Evaluated by orthopedics who worked up scoliotic curvature with imaging of the cervical, thoracic, and lumbar spine. Upon review, the patient was found to have a spinal cord that was split into two parts along the sagittal plane (diastematomyelia) and a wedge shaped vertebra (hemivertebrae). Referred to Neurosurgery for recommendations on management. Given the lack of symptoms, no surgical intervention was made. Neurosurgery observed curvature and did serial physical exams to monitor progression.
Discussions:
The outlook for patients with congenital scoliosis, diastematomyelia, and hemivertebrae who do not undergo surgery is not clear. When a neurological deficit is present in conjunction with congenital scoliosis, it is recommended to perform resection of diastematomyelia before proceeding with spinal correction. However, in some patients with pre-existing neurological abnormalities, unresected diastematomyelia caused progressive neurological deterioration. Therefore, prophylactic excision of hemivertebrae depends on the type (semi-segmented, incarcerated, fully segmented, nonincarcerated). The size of the curve and its progression are what should dictate the treatment of congenital scoliosis in the presence of diastematomyelia. Congenital scoliosis associated with intraspinal anomalies are rarely seen together. The few studies we found suggest the majority of patients are managed conservatively, even with neurological deficits. Surgery is indicated when follow up examinations present with progressive scoliosis and/or a worsening neurological exam. When managing a patient with scoliosis, its imperative to consult specialists in neurosurgery and orthopaedic surgery to closely follow and assess patients for changes in cobb angles, rule out tension on the spinal cord, and monitor for compression fractures.
Conclusions:
