Severe Thoracic Kyphosis with Neuropathy in a Three-Year-Old Child

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. This patient, who had been diagnosed in utero with CCAM of the lung, was born two months prematurely and was admitted to the neonatal intensive care unit for respiratory support. Routine computerized tomography (CT) of the chest revealed thoracic angular deformity with destruction of the seventh and eighth thoracic vertebral bodies and a lingular CCAM lesion of the left lung (Figs. 1A through 1-D). Differential diagnosis included congenital abnormality of the spine and vertebral osteomyelitis. Subsequently, she underwent lobectomy of the left upper lobe for the CCAM and debridement of the T7 and T8 vertebral bodies. Anterior strut-grafting was not performed because spondylodiscitis had not yet been diagnosed. During debridement, bone and disc tissue were sent for histopathological examination and cultures. Fig. 1 Fig. 1-A Posteroanterior radiograph of the spine shows the overlap of disc spaces between T5 and T10 caused by kyphosis. Fig. 1-B Lateral radiograph depicts the anomalous nature of the spinal vertebral bodies of T7 and T8 …