Abstract

Acute angulation at the thoracolumbar junction with segmental subluxation of the spine occurring at the level above an anteriorly hypoplastic vertebra in otherwise normal children is a rare condition described as infantile developmental thoracolumbar kyphosis. Three patient series with total of 18 children have been reported in the literature. We report five children who presented with thoracolumbar kyphosis and discuss the treatment algorithm. We reviewed the medical records and spinal imaging at initial clinical presentation and at minimum two-year follow-up. The mean age at presentation was eight months (two to 12). All five children had L2 anterior vertebral body hypoplasia. The kyphosis improved spontaneously in three children kept under monitoring. In contrast, the deformity was progressive in two patients who were treated with bracing. The kyphosis and segmental subluxation corrected at latest follow-up (mean age 52 months; 48 to 60) in all patients with near complete reconstitution of the anomalous vertebra. The deformity and radiological imaging on a young child can cause anxiety to both parents and treating physicians. Diagnostic workup and treatment algorithm in the management of infantile developmental thoracolumbar kyphosis is proposed. Observation is indicated for non-progressive kyphosis and bracing if there is evidence of kyphosis and segmental subluxation deterioration beyond walking age. Surgical stabilisation of the spine can be reserved for severe progressive deformities unresponsive to conservative treatment.

Cite this article: Bone Joint J 2015;97-B:982–7.

Aim: To assess if routine x-ray can be avoided following normal ultrasound in high risk screening for developmental dysplasia of the hip.

Methods: All children who had ultrasound as part of screening programme for developmental dysplasia of the hip during the period August 2006 and March 2007 were included for the study. After excluding 16 children due to incomplete details, either lack of clinical details/x-ray/ultrasound of the hip, 121 children were finally included for the study.

Results: Out of 121 children (242 hips), six of the hips were found to be dysplastic by ultrasound, average alpha angle being 43°, 2 of the hips turned out to be normal in subsequent X-rays. However three of the hips were found to be dysplastic in follow-up x-ray which was initially normal in the ultrasound, average alpha angle being 58.6°. The sensitivity in diagnosing developmental dysplasia of the hip by using α angle is 57% and 99% specific. The sensitivity did not improve by combining the alpha angle with percentage of femoral head coverage. Grafs α angle and percentage of femoral head coverage did not have any direct correlation with that of future acetabular index and hence routine x-ray still needs to be done to rule out developmental dysplasia of the hip.

Conclusion: Though the number of children involved in this study is small, three hips would have been missed if not followed up with x-ray, despite their percentage of coverage of femoral head being more than 50% and normal grafs α angle. Hence we recommend routine x-ray in the screening programme for developmental dysplasia of the hip despite initial normal ultrasound of the hip