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SPECIAL FEATURE X-ray. The wedging of thoracic vertebral bodies on three consecutive levels of the spine contributes to a minimum of 5° of kyphosis at each wedged vertebra, according to Dr. George. Clinical exams may be used to dif- Dr. Trinidad reviews the brain anatomy of this pregnant woman's baby to help the mother prepare for what to do after birth. Frequently diagnosed problems in utero are hydrocephalus, spina bifida, other birth defects and brain tumors. ENDOSCOPIC PRECISION HUMANS ARE DESIGNED to reabsorb the spinal fluid they produce in a day. For people who do not reabsorb their spinal fluid properly, the balance between production and reabsorp- tion is disrupted, resulting in hydrocephalus, which can be congenital or caused by trauma or tumors. Shunts can be used for communicating hydrocephalus to redistribute spinal fluid to the peritoneal cavity. For noncommunicating types of hydrocephalus, Elizabeth M. Trinidad, M.D., general and pediatric neurosurgeon at Neurological Surgery, P.C., performs endoscopic third ventriculostomy to redirect the flow of spinal fluid around a blockage. "We use an endoscope, inserted through a small hole in the head that passes through the brain and into the ventricle," says Dr. Trinidad. "By making a small opening in the floor of the third ventricle, fluid gains another avenue for getting around the aqueduct that is too narrow, so fluid can be reabsorbed properly." Dr. Trinidad also utilizes endoscopy for the fenestration of cysts in the brain. Because the open surgical technique for cyst fenestration necessitates opening part of the patient's skull, cysts located in easily accessible areas close to the surface are ideal for this method, says Dr. Trinidad. For cysts located in deeper, more sensitive locations of the brain, an endoscope can be used for visualization during an open procedure. Dr. Trinidad notes that for conditions such as loculated hydrocephalus, where pathways deep within the brain are connected, endoscopic visualization allows the surgeon visual access without having to disrupt more of the brain than is necessary for the procedure. Dr. George reviews all studies with patients along with their families. Spine models are used for demonstration purposes. ferentiate Scheuermann's kyphosis from postural kyphosis, or hunched back. When the back is hyperextended in a clinical exam, Scheuermann's kyphosis will not correct, and focal kyphosis will remain present, says Dr. George. The two treatment options for Scheuermann's kyphosis are bracing and surgery. The normal range of kyphosis curva- ture is between 10º to 40º. For patients whose kyphosis is greater than 45º but less than 75º and not highly focal, Dr. George uses a thoracolumbosacral orthosis (TLSO) brace developed for the thoracic and lumbar spine. Corrective surgical options may be recommended when the kyphosis is greater than 75º and the patient complains of back pain and demonstrates cosmetic deformities. Additional factors may include neurological deficits. For example, thoracic myelopathy may result from a herniated disc in the thoracic spine caused by pressure being placed on the spinal cord. Preoperatively, an MRI study is conducted to determine the presence and location of spinal cord compression to ensure the patient is unharmed during surgery to address spinal deformity. Mos t procedure s to rel ie ve Scheuermann's kyphosis are open due to the location in the thoracic spine. Dr. George performs a Ponte oste- otomy, in which the posterior thoracic bony anatomy is resected in a V-shape, allowing compression of the area after screws are placed to bring vertebra closer together. Fixing the Cracks Most commonly caused by stress fractures in the back, pediatric spon- dylolysis, a fracture in the spine in the pars region, manifests with back pain and spinal instability that responds to