Adolescent Spine (Guest Lecture)

Question 1

3 Common causes of general back pain in adolescents

Answer 1

1. Growth and puberty
2. Posture
3. Over use (sports specific leading to mm imbalances, backpacks)

Question 2

General Tx Outline for LBP

Answer 2

• Stretch what’s tight (flexibility)
• Strengthen what’s weak (core strength)
• Stabilize what’s imbalanced (posture)
• Modalities for pain
• Make it fun (for kids)

Question 3

When it’s not just “back pain” - 8 conditions

Answer 3

1. Spondylolysis/Spondylolysis
2. Anterolisthesis
3. Scoliosis
4. Scheuermann’s Kyphosis
5. Trauma
6. Infection
7. Neuromuscular
8. Rheumatoid/AVN/Neoplasm

Question 4

Condition: Starts as stress fx on the pars interarticularis, typically L5 followed by L4

Answer 4

Spondylolysis

Question 5

Condition: Widening of the pars interarticularis fx with increased pain and radiculopathy

Answer 5

Spondylolisthesis

Question 6

Non-Surgical Tx for Spondylolysis

Answer 6

1. Active REST (stop sport but maintain CRF)
2. Orthotics
3. PT

Question 7

Describe the difference between an anteriolisthesis and a retrolisthesis

Answer 7

Just indicates what moved and in which direction. Tx will be the same

Question 8

Condition: side to side curvature of the spine (Cobb angle) of > 10 degrees

Answer 8

Idiopathic scoliosis (more common in females)

Question 9

Sx of Idiopathic Scoliosis

Answer 9

1. Pain
2. Radiculopathy from neural tension
3. Cardiopulmonary complications - effect of scoliosis on rib cage and rib functions
4. Postural comepensation

Question 10

Describe the Schroth Method

Answer 10

A method to correct spinal rotaiton and increased lung capactiy with rotational breathing

Question 11

Describe how growing rods (Phenix) work to correct scoliosis in growing children

Answer 11

Either anterior or posterior rods are placed in the spine. Two rods threaded in opposite directions are connected with a magnetic component. 2 weeks after surgery the rods can be lengthened by rotation a magnet on the skin over the magnetic component in the spine.

Typically the are lengthened by 0.2 mm 5 out ot 7 days a week

Question 12

Condition: Increased thoracic kyphosis with compensatory cervical and lumbar lordosis

Answer 12

Scheuermann’s Kyphosis

Question 13

Condition: Compression fx to the vertebral body

Answer 13

Burst Fx

Question 14

Condition: Transverse fx of the vertebral body right under the epiphysis, flexion and distraction fx

Answer 14

Chance Fx

Question 15

Condition: Typically occurs in vertebrae from T12-L2

Answer 15

Chance fx

Question 16

Describe how you would tx acute disc herniation in children compared to adults

Answer 16

Trick question: you tx them just like adults

Acute disc herniation in rare in children due to the strength of their connective tissues, however, when they do occur most are 12+ yo, most are also in L4-L5, L5-S1

Question 17

Condition: also known as a limbus fx, caused by excessive compression or distraction and present like a disc herniation

Answer 17

Apophyseal ring fx

Can think of it as a salter harris fx to the growth plate in the vertebral body

Question 18

4 Spine conditions caused by infection

Answer 18

1. Vertebral osteomyelitis
2. Septic arthritis
3. Discitis
4. Transient bacteremia (bacteria in blood)

Question 19

Describe what you should consider in those pts. with sickle cell anemia

Answer 19

When in vaso-occlusive crisis they can present with localized back pain

Prolonged episodes of vaso-occlusive crisis can lead to bone and bone marrow infarction which has clear implications for the spine

Question 20

Describe how Juvenile Anklyosis Spondylitis differs from Adult Anklyosis Spondylitis

Answer 20

While the adult condition typically begins at the SI joint and ascends in children the condition tyipcally begins in the peripheral joints

In children it typically take 4-8 yrs from sx onset to reach a dx

Question 21

3 Themes from the Adolescent Spine Lecture

Answer 21

1. Times of growth and the kinetic chain (Strength and Flexibility + Postural compensation = potential for problems)
2. Address the imbalances (stretch the tight, strengthen the weak – this can change over course of tx)
3. Education (age and sport/activity specific)