Daniel J. Finch

Significance Statement: In the United States, dialysis provision is an example of a robust, single-payer dominant system with cost containment. When compared with the cost of dialysis in other countries, Medicare dialysis costs in the United States as a function of overall health care expenditures are approximately $60,000 per patient less than expected, likely due to substantial cost containment imposed by Medicare as the dominant payer.

Case: A 14-year-old adolescent girl with Crane-Heise syndrome—the oldest such patient in the literature—presented to our clinic with progressive scoliosis, including a 90° T6-L3 apex right curve. She underwent a T3-pelvis posterior spinal fusion. Intraoperatively, she had small, poorly visualized upper thoracic pedicles, incomplete fusion of the posterior spinal elements, and limitations of intraoperative neuromonitoring. Adherence to dysplastic scoliosis principles allowed for an uncomplicated procedure with an excellent correction. Conclusion: We discuss the surgical management of scoliosis in an adolescent with Crane-Heise syndrome. This is a very rare skeletal dysplasia, with 9 reported cases in the literature.