Disc space infection in children: magnetic resonance imaging.

The diagnosis of childhood intervertebral disc space infection is often delayed. Establishment of the correct diagnosis is imperative to preclude unnecessary procedures and to exclude other, more serious, diagnoses that would require aggressive management. MRI is a noninvasive technique that is very sensitive for disc space infection in children.

Injuries of the shoulder and arm.

A systematic approach to the injured shoulder includes careful history taking and sequential examination of all anatomic components of the shoulder girdle in each and every patient. High quality radiographs, with two views at 90 degrees to one another, are essential. A specific diagnosis can and must be made on every patient with an injured shoulder to enable referral for proper care and follow-up.

Orthopaedic management of the lower extremities in spina bifida.

Myelodysplasia is a multisystem disease that requires a multidisciplinary approach. The orthopaedist is often the first to identify a changing neurologic picture or deformity and must work closely with neurosurgical colleagues to identify correctable neurologic lesions. The role of the orthopaedist begins at the birth of the child with spina bifida. At this time, the level of neurologic involvement can be determined. Education of the parents can then begin by outlining the expected ambulatory potential of the child, and predicting deformities or complications that might be anticipated depending on the level of neurologic involvement. The orthopaedist must also emphasize the extreme importance of neurosurgical care in preventing deterioration of neurologic function, so that goals for ambulation and musculoskeletal function can be achieved. As the child gets older, motor milestones paralleling those of a normal child should be sought with use of a corner chair or sitting device, followed by the use of a standing frame if needed. If appropriate, the child will then progress to full-control braces, with weaning as determined by neurologic level of involvement . Long-term mobility may be achieved by bracing or by the use of a wheelchair. A realistic approach must be taken in goal-setting, so that a child is not pressured to achieve unrealistic goals yet is enabled to achieve full functional capacity.

Sensitivity of spinal cord monitoring to intraoperative events.

Intraoperative somatosensory evoked potentials in 50 patients were reviewed; each waveform was correlated with intraoperative surgical events and conditions. Twenty-two patients maintained reproducible waveforms and awoke without neurological deficit. Two patients had random waveform changes not correlated with a surgical event and awoke without deficit. Twelve patients showed waveform changes temporally related to circumstances that might endanger cord function; two of these awoke with transient neurological abnormality. Satisfactory waveforms were not obtained from 14 patients. Somatosensory evoked potential monitoring in scoliosis surgery appears to be sensitive, but may not be sufficiently specific; waveform changes do not necessarily indicate objective neurological damage.

Magnetic resonance imaging of the spinal cord in spinal dysraphisms.

Magnetic resonance imaging (MRI) was performed 49 times in 42 patients with spinal dysraphism. Scoliosis and a changing neurological picture were the primary indications. Spinal cord anomalies included hydromyelia, diastematomyelia, lipoma, thickened filum terminali, and spinal cord atrophy. All but one patient exhibited Arnold-Chiari malformation. Twenty-two of the 42 patients had computed tomography (CT) scans, myelograms, or operations that corroborated the 41 MRI findings. Three false-positive MRI findings of hydromyelia and no false-negative studies were observed. MRI is a noninvasive investigative technique that provides more information than myelography or CT in defining spinal cord anatomy in spinal dysraphism.

Magnetic resonance imaging in the diagnosis of childhood discitis.

Diagnosis of disc space infection in childhood is often delayed and is usually made on the basis of multiple roentgenographic, laboratory, and nuclear imaging studies. Four cases of septic discitis in children are described. Special emphasis is placed on the diagnostic findings with magnetic resonance imaging. Magnetic resonance sensitivity for this entity and its role in comparison with other imaging modalities are discussed.

Extension-abduction contracture of the spastic hip.

Patients with cerebral palsy and fixed hip extension are often unable to sit and therefore lose social and educational opportunities. At Texas Scottish Rite Hospital (Dallas, TX, U.S.A.), 29 patients had hip extension-abduction contractures. Eleven patients with mild involvement were managed with physical therapy. Six patients had moderate involvement and required wheelchair modification to maintain sitting. Twelve patients demonstrated severe contractures that required major soft tissue releases and often femoral shortening osteotomies to regain flexion. Patients with athetosis or rigidity were identified as those most likely to develop extension-abduction contractures either spontaneously or following adductor releases.