An 8-year-old male was referred to a paediatric clinic for an incidentally found CM-I and cervicothoracic syrinx identified during a preoperative workup prior to the surgical management of a progressive thoracolumbar kyphosis. The child has been experiencing daily headaches but denied dysphagia, neck pain, or numbness, or weakness in the upper extremities. His family also noted difficulty with hand coordination and strength when compared to his peers. He was born via caesarian section at 41 weeks with a birth weight of 8 pounds and 12 ounces. He also underwent a bone marrow transplant at the age of 14 months.
Examination
The patient was alert and oriented with clear speech and normal cranial nerve function on physical examination. Muscle strength was 5/5 in bilateral biceps, triceps, and deltoids, 4+/5 in hand grip and finger abduction. Deep tendon reflexes were grade 2/4 in the upper and lower extremities with a negative Hoffman's sign bilaterally, no ankle clonus, and a down-going Babinski test bilaterally. The patient was unable to perform a single-leg stance. The patient underwent suboccipital craniectomy, measuring 3 × 3 cm, C1 laminectomy, intradural exploration with coagulation of cerebellar tonsils, lysis of arachnoid adhesions, resection of thick posterior arachnoid membrane, and duraplasty measuring 3 × 3 cm utilizing Dura-Guard and DuraSeal. MRI was done preoperatively and 3-months postoperatively. Spinal imaging was also done.
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