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MIDS 187 > Ch 12 Spine > Flashcards

Ch 12 Spine Flashcards

1
Q

Are congenital spine anomalies common?

A

Yes - will see them in practice

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2
Q

How does the spine look in TRV by the 16th week of gestation?

A

Looks like 3 echogenic ossification centers, surrounding the neural canal

(2 lie posterior to spinal canal within laminae + 1 is anterior within vertebral body)

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3
Q

How does the TRV spine look at the cervical, thoracic, lumbar + sacral level?

A

C: posterior ossification centers have a quadrangular shape

T/L: inverted triangle shape with base towards dorsum of fetus

S: posterior ossification centers have a wider placement than upper vertebrae

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4
Q

What is the classic spinal image?

A

Taken in SAG - often shows its entirety as a parallel structure ending in pointed sacrum

(parallel lines = represent 2 ossification centers: the vertebral body + posterior arch)

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5
Q

The SAG spine images the neural tube in 1st trimester + what during the other trimesters?

A

Spinal cord

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6
Q

In the 2nd/3rd trimesters, ____ images at the 2nd + 3rd lumbar spine levels?

A

The conus medullaris

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7
Q

List 3 things that determine if the spine is normal?

A

-Intact neural canal
-Intact dorsal skin contour
-Normal location + shape of spinal ossification centers

(imaging the conus medullaris in SAG can increase confidence that spine is normal)

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8
Q

How many planes do we image the spine in at minimum?

A

-SAG
-TRV (axial)

(imaging in coronal is good to do as well tho)

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9
Q

What is the spine protocol we follow?

A

SAG + TRV: C, T, L + S spine
Coronal: S spine

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10
Q

Is there always a bit of AFP in amniotic fluid?

A

Yes - if there are elevated levels that is abnormal

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11
Q

The spine can be screened by what 2 things?

A

-U/s
-Biochemical testing

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12
Q

MSAFP levels occur through diffusion across what?

A

The placenta + amnion

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13
Q

What types of defects result in higher AFP levels entering the amniotic fluid?

A

Structural defects - like anencephaly or spina bifida

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14
Q

What prevents AFP from escaping fetal circulation + results in a normal amniotic AFP level?

A

Skin covered or closed neural tube defects (NTDs)

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15
Q

What forms the neural tube during the 3rd week of embryonic life?

A

Infolding of the slipper-shaped ectoderm of the neural plate

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16
Q

What fuses to form the neural tube?

A

The neural groove - it begins midembryo + is completed at cranial + caudal neuropore

(is a 2 day process)

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17
Q

What factors can cause closure failure of the neural tube at either end of it, demonstrating the connection b/w spina bifida + caudal defects?

A

A disruption to the 2 day process by infections, drugs or genetic factors

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18
Q

What is spina bifida?

A

-NTD from incomplete closure of the bony elements of the spine (the lamina + spinous processes) posteriorly

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19
Q

List the 2 types of spina bifida defects?

A

Ventral: involves vertebral body splitting + development of a neurogenic origin cystic structure

Dorsal (m/c): has subdivisions of open (not covered by skin) + closed (covered by skin) forms

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20
Q

Where do ventral spina bifida lesions occur?

A

At lower cervical + upper thoracic spine (are uncommon)

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21
Q

What is spina bifida occulta?

A

-Split vertebrae closed + covered by skin
-M/c at sacrolumbar level
-Not noticeable on surface, except for small tuft of hair or dermal lesion over affected area
-Incidental finding

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22
Q

What is spina bifida aperta?

A

-Open + not covered by skin (exposing neural canal)
-Full thickness defect of skin, tissues + vertebral arches
-This lesion occurs in 85% of all spina bifida cases

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23
Q

Differentiate a meningocele vs a myelomeningocele?

A

Meningocele: lesion has thin meningeal membrane that does NOT contain neural tissue

Myelomeningocele: neural tissue inside the protruding sac

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24
Q

Is closed spina bifida aperta inconsequential?

A

Yes - b/c skin is covered it has minimal neural involvement

(15% of time this occurs)

25
Q

85% of spina bifida aperta is open or closed?

A

Open: 2 subdivisions
-Meningocele (sac w/o spinal cord)
-Myelominingocele (sac with spinal cord)

26
Q

What causes a NTD?

A

Genetics, nutritional factors, environmental factors, or a combo of things

27
Q

Are males or females m/c to have spina bifida?

A

Females

28
Q

NTDs have a high concordance rate in MZ or DZ twins?

A

MZ

29
Q

How to sonographically assess for spina bifida?

A

-Best seen in SAG
-Use TRV to rule out smaller defects
-Look for banana + lemon sign in head (it distorts the shape of brain + cerebellum)

30
Q

What is the only definitive way to make a diagnosis of spina bifida?

A

Viewing of a meningomyelocele

31
Q

How does spina bifida look in TRV?

A

-Vertebral segments has a “U” or “V” shape
-Splays (widens) the posterior ossification centers

32
Q

What causes displacement of cranial structures into the foramen magnum + superior cervical canal with spina bifida?

A

CSF leakage

33
Q

If the cranium appears normal, does this exclude a myelomeningocele?

A

Yes

34
Q

The differentiation b/w open + closed forms of spina bifida are best shown by what?

A

Sonographic demonstration of abnormal or normal cranial anatomy

35
Q

What head anomaly occurs in the 2nd trimester when spina bifida aperta is present?

A

Hydrocephalus (70% of time)

36
Q

Spina bifida shows what type of lower extremity deformities?

A

-Bilateral clubfeet
-Rocker bottom feet (curved bottom of feet)
-Hip deformities

37
Q

What is kyphoscoliosis?

A

Combo of abnormal lateral + anterior curvature of spine

38
Q

How is scoliosis + kyphosis best imaged?

A

Scoliosis: coronal
Kyphosis: SAG

39
Q

What is scoliosis?

A

Lateral displacement of anterior ossification centers

40
Q

Is scoliosis an isolated finding?

A

It can be isolated or seen with other findings

41
Q

During the 1st trimester, what 2 sonographic features indicate caudal regression syndrome?

A

-Short CRL
-Abnormal YS

42
Q

What is caudal regression syndrome?

A

-Rare congenital anomaly affecting the caudal spine, spinal cord, hindgut, urogenital system + lower limbs

-Ranges from agenesis of coccyx to absence of sacral, lumbar + lower thoracic vertebrae

43
Q

This factor increases the risk of caudal regression syndrome 250x?

A

Maternal diabetes

44
Q

SAG + TRV views of the spine with caudal regression syndrome uncover what?

A

-Absence of vertebrae
-Fused iliac wings
-Decreased femur head distance
-Short femurs
-Clubfeet

45
Q

What is the m/c location for teratomas to develop?

A

Caudal end (sacrococcygeal)

46
Q

What is the m/c neoplasm in the newborn?

A

Sacrococcygeal teratomas (m/c in females)

47
Q

Where can teratomas develop?

A

Gonads, umbilical cord, placenta, anywhere in neural tube + caudal end

48
Q

What is a sacrococcygeal teratoma?

A

Rare germ cell tumor that forms on fetus’s tailbone/coccyx (usually benign)

(male fetuses have increased chance of developing malignant form)

49
Q

Most sacrococcygeal teratomas are what type?

A

Type 1 or 2

50
Q

How do sacrococcygeal teratomas appear on u/s?

A

-Protrusion b/w anus + coccyx (some can develop in presacral space of pelvis)

-Solid or complex with cystic parts

-Choroid plexus secretes CSF within tumor, resulting in a cystic component

51
Q

Fetus’s are at risk for developing what 2 things if they have a sacrococcygeal teratoma?

A

-Congestive heart failure
-Hydrops

52
Q

Perinatal mortality + morbidity are related to what type of failure if they have a sacrococcygeal teratoma?

A

Related to high output cardiac failure - due to arteriovenous shunting within tumor, hydrops, polyhydramnios + preterm delivery

53
Q

What is fetal hydrops?

A

Condition in which large amounts of fluid build up in a baby’s tissues and organs, causing extensive swelling (edema)

54
Q

T/F: Skin covered NTD lesions prevent a rise in MSAFP levels.

A

True

55
Q

The posterior elements of the spine seen on u/s are called what?

A

Laminae

56
Q

What are the 3 dots we see of the spine in TRV?

A

-2 posterior laminae
-1 anterior body

57
Q

What are the 2 types of spina bifida called?

A

Occulta (closed) + aperta (open)

58
Q
A

MIDS 187 (19 decks)

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