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17 Cards in this Set

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Structural vs functional spine deformities
STRUCTURAL - congenital (malformation), neuromuscular, mesenchymal, tumor, trauma or infection, rheumatic, bone dysplasias, metabolic, iatrogenic, idiopathic
FUNCTIONAL - postural, hysterical, nerve root irritation, inflammatory (appendicitis), leg length inequality, hip contractures
Adolescent Idiopathic Scoliosis (AIS)
- Structural lateral curvature of spine occuring at or near onset of puberty for which no cause can be established
- <10 degrees - 2-3%, girls 3.6:1
2 factors predicting curve progression
- Lesser maturity and larger curve magnitude
Pulmonary function and mortality with scoliosis
- Patients with high angle thoracic curves of >100 degrees at increased risk of cor pulmonale
- In nonsmokers, significant FVC limitations do not occur until 100-120 degrees
- Lesser curves with significant hypokyphosis may have more pulmonary loss
X rays in patients with scoliosis
- Standing x ray of spine - requires special grid for entire spine
- If structural LLD is present block under short limb till crests are level
- LOOK AT X RAYS CAREFULLY
- Look for interpendicular widening, congenital abnormalities, rib pencilling and skeletal maturity
Curve patterns in scoliosis
TYPICAL IDIOPATHIC CURVE - lumbar (apex left), thoracic (apex right)
ATYPICAL CURVES - lumbar (apex right), thoracic (apex left), long c-shaped, curve with short sharp apex
Infantile Idiopathic Scoliosis
- Birth to 3 years old
- At apical vertebrae the rib on convex side in more acute
- Compare difference between both sides
- >20 degrees difference indicates 80% chance of progression
Juvenile Idiopathic Scoliosis
- 4-10 years old
- High incidence of neuroaxis abnormalities
- Need MRI
- RAD >10 degrees indicates progression
Neuromuscular scoliosis
- Neuropathic - upper motor neuron
- Diastemotomyelia - boney or fibrous defect that splits the spinal cord, as child grows and the spine elongates traction occurs on the cord
- Diplomyelia - split cord
- Tethered cord - traction on end of cord (thickened filum terminale, lipoma)
- Myelomeningocele - neural tube defect
- Hydrosyrinx - expansion of spinal cord with CSF, scoliosis improves and sometimes resolves when syrinx is treated
- Lower motor neuron - polio, SMA, dysautonomia
- Myopathic - muscular dystrophies, arthrogryposis
Evaluation of congenital scoliosis
- Heart (10%) - clinical or echo
- GU (25%) - all patients need renal evaluation
- Spinal cord - all patients needing surgery or abnormal neuro exam require MRI
- Klippel-Feil - 25%
Congenital scoliosis treatment
- Very little for bracing - possible exception with compensatory curves
- Hemiepiphyseodesis - appears effective in correcting some below age of 7 years
- Fusion location depends upon area of growth failure
- Fuse early before the curve gets bad and osteotomy is required
Congenital Muscular Torticollis
- Head side bent and rotated
- Contracted SCM
- Occasionally can palpate thickening in muscle
- Treatment - gentle stretching, place crib toys, mirrors on opposite side
- Greater then 80% resolve by 1 year
- If not resolved by 1 year may require surgery
Klipple Feil - congenital cervical spine fusions
- Incidence 0.7
- Etiology - homox gene
- Associated problems - Sprengels, GU, hearing problems/deafness, synkinesis (mirror movements), pulmonary problems, congenital heart disease, spinal cord
Down syndrome is associated with what abnormality of spine
- Ligametous laxity
- C1-C2 instability - fusion can be difficult and hazardous, most people base on symptoms, natural history is controversial, x ray age 5-15
- Occipital cervical instability - easily overlooked
Spondylolisthesis and spondylolysis
- Defect of posterior elements with fracture or slippage
- Not always painful
- Initially try to control symptoms with activity limitations, bracing if defect appears fresh attempting to heal or unresponsive to activity modifications, surgery for recalcitrant symptoms
Scheuermann Disease
-Inflammation of growth plates of vertebral bodies
- Increased thoracic kyphosis most common site
Discitis
- Inflammatory lesion of intervertebral disc
- Narrowing disc space
- Self-limiting inflammation
- Disc space infection - infants and children < 5 years old, S. aureus