Titaniumed- You said you would post some relevant questions to ask a surgeon? Let me type the report from my last visit to an Ortho. who said he wasn't comfortable handling my case. I'm going to see Dr. Orr at Cleveland Clinic in a few weeks.....
HISTORY:This is a 29 year old male with most likely the diagnosis of Marfan Syndrome who presents with rather severe chest pain. On physical exam, the patient is 6'9". He appears to have an arm span greater than height. On grasping his wrist, his thumb overlaps the entire distal phalanx of his long finger. The patient denies any previous eye problems.
The evaluation of the back reveals moderately severe double structural thoracolumber curve. The patient has severe chest wall deformity; particularly on the right side with significantly diminished right chest volume from a combination of unexpected narrowing of the thoracic chest wall anteriorly as well as a severe right rib hump. It should be noted that this is the site of the patients most extreme pain. The patient otherwise appears to be fairly well balanced in the sagittal and coronal planes. However, he does have a significant right thoracic, left lumbar curve. Neurologically, the patient is alert and oriented times three, cranial nerves are intact, no objective distal dysesthesias.
Diagnostic X-rays AP and lateral and scoliosis views obtained. The patient has a 68-degree thoracic curvature with severe rib hump. The patient has a significant 60-degree lumbar curve. The patient appears to have significant ankylosis across the disc spaces particularly in the lumbar spine on the concave side.
PLAN:At this time, secondary to severe thoracolumbar scoliosis would reccpmend the patient be referred to either the Cleveland Clinic or Ann Arbor for evaluation of the scoliosis. At this juncture, unfortunately I suspect that his curves have largely stabilized through degenerative processes and subsequent ankylosis and therefore are not likely to progress. However, secondary to his quite complex nature, I believe he would be best treated by someone more experienced with treating of scoliosis and Marfan's. We will therefore see if we cannot get him a referral.
David A. Beeks, M.D.
DAB/dls
Any thoughts?
HISTORY:This is a 29 year old male with most likely the diagnosis of Marfan Syndrome who presents with rather severe chest pain. On physical exam, the patient is 6'9". He appears to have an arm span greater than height. On grasping his wrist, his thumb overlaps the entire distal phalanx of his long finger. The patient denies any previous eye problems.
The evaluation of the back reveals moderately severe double structural thoracolumber curve. The patient has severe chest wall deformity; particularly on the right side with significantly diminished right chest volume from a combination of unexpected narrowing of the thoracic chest wall anteriorly as well as a severe right rib hump. It should be noted that this is the site of the patients most extreme pain. The patient otherwise appears to be fairly well balanced in the sagittal and coronal planes. However, he does have a significant right thoracic, left lumbar curve. Neurologically, the patient is alert and oriented times three, cranial nerves are intact, no objective distal dysesthesias.
Diagnostic X-rays AP and lateral and scoliosis views obtained. The patient has a 68-degree thoracic curvature with severe rib hump. The patient has a significant 60-degree lumbar curve. The patient appears to have significant ankylosis across the disc spaces particularly in the lumbar spine on the concave side.
PLAN:At this time, secondary to severe thoracolumbar scoliosis would reccpmend the patient be referred to either the Cleveland Clinic or Ann Arbor for evaluation of the scoliosis. At this juncture, unfortunately I suspect that his curves have largely stabilized through degenerative processes and subsequent ankylosis and therefore are not likely to progress. However, secondary to his quite complex nature, I believe he would be best treated by someone more experienced with treating of scoliosis and Marfan's. We will therefore see if we cannot get him a referral.
David A. Beeks, M.D.
DAB/dls
Any thoughts?
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