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Severe Thoracic Kyphosis with Neuropathy in a Three-Year-Old ChildA Case Report
Senthil T. Nathan, MD1; Alvin H. Crawford, MD1; Marios G. Lykissas, MD, PhD1; Francesco T. Mangano, DO1
1 Divisions of Orthopaedic Surgery (S.T.N., A.H.C., and M.G.L.) and Pediatric Neurosurgery (F.T.M.), Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2017, Cincinnati, OH 45229-3039. E-mail address for S.T. Nathan: senorth2002@yahoo.co.in
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Investigation performed at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jul 24;3(3):e77 1-5. doi: 10.2106/JBJS.CC.L.00260
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Childhood spondylodiscitis occurs in 0.4 to 2.4 per 100,000 children each year1. Early diagnosis is important to prevent the development of major complications such as sepsis, spinal cord injury, and severe angular thoracic kyphosis. We report a rare case of a child who first presented as a two-month-old premature infant with an initial diagnosis of congenital cystic adenomatoid malformation (CCAM) of the lung and spondylodiscitis of the seventh and eighth vertebrae of the thoracic spine. The aim of the report is to highlight some challenges in identifying spondylodiscitis in very young children, including difficulty with the detailed neurological evaluation, the need for serial neuromonitoring assessments, progression of spinal deformity following attempted posterior spinal fusion, and technical difficulties involved in corrective surgery. The patient’s family was informed that data concerning the case would be submitted for publication, and they provided consent.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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