A Case of a Child with “Idiopathic” Scoliosis

Abstract

Back pain is a frequent chief complaint in a pediatric primary care physician office. While back pain is not uncommon in children and adolescents, it is not typical of adolescent idiopathic scoliosis. A child presenting with back pain and scoliosis must undergo a thorough history and physical examination to rule out features of atypical scoliosis including headaches, night pain or fevers, or abnormal neurologic findings. If those findings are identified, or if radiographs suggest an atypical scoliosis, urgent referral to an orthopedic surgeon trained in pediatric spinal deformity is indicated. Radiographic findings on PA and lateral views of the entire spine can include large curves, left thoracic curves, and curves associated with hyperkyphosis. In this case, MRI of the entire spine demonstrated a Chiari malformation and a large thoracic syrinx. She was referred to a pediatric neurosurgeon who treated her surgically prior to orthopedic intervention.