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17 Cards in this Set
- Front
- Back
Structural vs functional spine deformities
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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 |
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Adolescent Idiopathic Scoliosis (AIS)
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- 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 |
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2 factors predicting curve progression
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- Lesser maturity and larger curve magnitude
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Pulmonary function and mortality with scoliosis
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- 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 |
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X rays in patients with scoliosis
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- 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 |
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Curve patterns in scoliosis
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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 |
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Infantile Idiopathic Scoliosis
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- 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 |
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Juvenile Idiopathic Scoliosis
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- 4-10 years old
- High incidence of neuroaxis abnormalities - Need MRI - RAD >10 degrees indicates progression |
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Neuromuscular scoliosis
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- 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 |
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Evaluation of congenital scoliosis
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- 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% |
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Congenital scoliosis treatment
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- 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 |
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Congenital Muscular Torticollis
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- 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 |
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Klipple Feil - congenital cervical spine fusions
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- Incidence 0.7
- Etiology - homox gene - Associated problems - Sprengels, GU, hearing problems/deafness, synkinesis (mirror movements), pulmonary problems, congenital heart disease, spinal cord |
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Down syndrome is associated with what abnormality of spine
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- 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 |
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Spondylolisthesis and spondylolysis
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- 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 |
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Scheuermann Disease
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-Inflammation of growth plates of vertebral bodies
- Increased thoracic kyphosis most common site |
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Discitis
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- Inflammatory lesion of intervertebral disc
- Narrowing disc space - Self-limiting inflammation - Disc space infection - infants and children < 5 years old, S. aureus |