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27 Cards in this Set
- Front
- Back
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With congenital scoliosis, the defect occurs at how many weeks of gestation?
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4 to 6 weeks
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Patients must also be evaluated for which two conditions? Why?
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Renal anomalies (abdominal ultrasound)
Heart disease Because these systems develop at same point in gestation |
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What are the two components of the general classification of congenital scoliosis?
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I: failure of segmentation (bar)
II: failure of formation (hemivertebra) |
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Which type has the best prognosis? Which has the worst?
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Best: block vertebrae (bilateral failure of segmentation)
Worst: unilateral unsegmented bar with contralateral fully segmented hemivertebra |
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What is the treatment for unilateral fully segmented hemivertebra?
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Fuse at presentation with combined anterior/posterior procedure
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What is the treatment for other types of congenital scoliosis?
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Await progression
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What is the classic form of treatment? What is the notable exception?
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Classically. posterior spinal fusion in situ
Exception: combined anterior/posterior fusion if significant crank shaft risk |
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What are the two other surgical options and their associated criteria?
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Hemivertebra excision (curve>40 degrees; especially L4, L5)
Anterior/posterior hemiepiphysiodesis (curve>40 degrees) |
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Which type has the worst prognosis? Why?
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Failure of formation (type I)
Because it is most likely to result in paraplegia |
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What is the surgical procedure of choice?
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Posterior spinal fusion (because crank shaft is desirable)
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An anterior approach also be considered with curves of which magnitude?
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>55 degrees
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What is the definition of diastematomyelia?
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Longitudinal cleft in cord
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With what condition is diastematomyelia associated?
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Cord tethering
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What is key radiographic feature suggestive of diastematomyelia?
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Intrapedicular widening
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What is the treatment if asymptomatic?
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Oberservation
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How can sacral agenesis be differentiated from myelomeningocele?
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Protective sensation present, but motor function still absent
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what is the classic physical exam finding?
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Dimpling buttocks
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What is the characteristic gait pattern of these patients?
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Trendelenburg
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What are the two treatment options?
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Amputation
Spinal-pelvic fusion |
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What are the two diagnostic criteria for Scheuermann's Disease?
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>45 degrees thoracic kyphosis
>5 degrees anterior wedging of three sequential vertebrae |
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Scheuermann's may be associated with what three spinal conditions?
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Spondylolysis
Scoliosis Schmorl's nodes |
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What gender is commonly affected?
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Male
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What are the two indications for bracing?
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Kyphosis <75 degrees
Skeletally immature patient |
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What are the three criteria for surgical intervention?
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Skeletally mature patient
Kyphosis>75 degrees Does not correct to <55 degrees (relatively inflexible curve) |
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What it the surgical procedure of choice?
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Posterior spinal fusion with or without anterior release and fusion
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What levels should be included in the fusion? What are the proximal and distal extents?
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T2 proximally
One level beyond lordosis distally |
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What are the two common complications of operative treatment?
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SMA syndrome
Junctional kyphosis |
