Hyperkyphosis as an indicator of syringomyelia in idiopathic scoliosis: a case report.

STUDY DESIGN: A case of thoracic hyperkyphosis is reported as an atypical presentation of otherwise typical adolescent idiopathic scoliosis that showed a large syringomyelia on magnetic resonance imaging. OBJECTIVE To review atypical curve patterns that indicate the need for more intensive preoperative workup including a magnetic resonance imaging scan. SUMMARY OF BACKGROUND DATA: The literature on atypical curve patterns of adolescent "non-idiopathic" scoliosis is reviewed. No report in the literature describes patients with an idiopathic coronal plane and thoracic hyperkyphosis as an atypical feature found to have a large syringomyelia and Chiari I malformation on magnetic resonance imaging examination. METHODS: The clinical and radiographic features associated with thoracic hyperkyphosis and juvenile and adolescent scoliosis with syringomyelia are presented. RESULTS: The neurosurgical treatment of the syringomyelia subsequently led to a potentially safer spinal fusion. The patient tolerated the procedures well and at this writing has remained asymptomatic during 3 years of follow-up evaluation. CONCLUSIONS: The reported case adds to the hyperkyphosis literature category of unusual spinal deformities seen in scoliosis associated with syringomyelia and should further help to categorize adolescent idiopathic scoliosis as a diagnosis of exclusion.