Patient: A nine-month-old baby has a right curvature deformity of the cervicothoracic spine, C4-T1 vertebrae deformity (butterfly spine), and the shoulder is high on one side and low on the other, which is more obvious. How should I treat it? There is also myalgia. Do I need surgery? I was born by cesarean section. Do I need surgery? Is myotonic neck caused by scoliosis? If I have surgery, will it become normal? Is this deformity caused by childbirth?
Fu Lingjie, Department of Orthopedics, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine.
Hello: Girl, nine months old, high right shoulder, X-ray report C4-T1 butterfly vertebrae, combined with myelopathy.
The X-rays are frontal and lateral cervical spine and thoracic films respectively, and the photos show a high right shoulder. The head is tilted to the right side.
Analysis.
1. It is recommended that a full-length spine film be taken to clarify the overall balance problem and the specific segments of the butterfly spine, and that a before-and-after comparison be taken again three months later, and that plaster fixation be recommended if the deformity progresses. If the deformity progresses, it is recommended to fix the plaster. Myotonic squint can be corrected by massage, physiotherapy, support bureau or plaster fixation. Early correction of deformed oblique neck is more effective, and it is not only a neck deformity, but also can be combined with facial developmental asymmetry. Butterfly spine is a hemivertebral deformity caused by disorders in the development process of the vertebral body, there are many forms and combinations, and the prognosis also has some differences, one side of the butterfly spine combined with the other side of the bone bridge formation deformity is more likely to progress, the probability of surgery is relatively large.
2, there is no indication for surgery, hemivertebral deformity is a developmental problem, and oblique neck are two different problems, and the production process is not obviously related. As the vertebral body deformity and oblique neck may be present, the possibility of combining other deformities cannot be ruled out.
3. Since you did not describe any other problems other than the deformity, I assume that the sensation and movement of the child’s limbs are normal and that there is no problem with urination and defecation.
Patient: Yes, urination and defecation are normal, and the movement of the limbs is strong and unimpeded. Her right hand is quite flexible, but she did not like to use her right hand until 3 or 4 months ago. Later, she started to use her right hand more frequently.
Patient: The baby likes to tilt her head to the right, and her shoulders are high and low, no e abnormal. Love jumping and jumping is very smart
Fulingjie, Department of Orthopedics, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine.
Hello, the quality of the film is much better, visible C4-T1 hemivertebral deformity, although the report does not write T2, but visible mild wedge, do not exclude the possibility of deformity also exists, cervical lateral film visible physiological bending of the cervical spine is still possible.
1, the left side of the cervical-thoracic spine curvature, caused by multiple vertebral hemivertebral deformity, can be three months after the film review before and after the comparison of progress.
2, head tilt to the right, vertebral deformity can lead to, but the sternocleidomastoid muscle report suggests bilateral asymmetry, should be combined with muscular oblique neck, can massage, heat, manipulation and other conservative treatment, early treatment effect is better.
3, the good news is that the T3-T12 vertebral body shape did not see obvious abnormalities, the child’s neurological function is not involved.
4, if the cervicothoracic hemivertebral deformity progresses rapidly can be plastered orthopedic, delaying the rapid progress of deformity, can choose around school age orthopedic surgery.
Patient: Thank you for your answer, if you do the surgery is it possible to do the oblique neck and bone deformity at the same time at once? Also: What is the cause of scapular arching?
Fu Lingjie, Department of Orthopedics, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine.
The bilateral inconsistency of scapula height may be the cause of cervicothoracic segment deformity, which is a secondary change. No bony abnormality of the scapula is seen from the chest X-ray.
Patient: I now take her to the Chinese hospital every day for massage, is this useful for her recovery? By the way, when the baby sits and stands on her own, her upper body will bend to the good side unconsciously, is this because of the oblique neck or spinal deformity? Thank you very much for increasing my chances. I really appreciate it.
Fulingjie, Department of Orthopedics, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine.
There should be no problem in the rehabilitation department of a regular hospital. In addition, the child will adjust her own balance, so her posture is in her best interest. For example, a patient with a hunchback may tilt her neck back so that she can look forward and reach balance.