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AAOS Section 10 - Pediatrics > Chapter 140 - Pediatric Spine > Flashcards

Chapter 140 - Pediatric Spine Flashcards

(51 cards)

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1
Q

normal thoracic kyphosis

A

20-45 degrees

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2
Q

normal lumbar lordosis

A

30-60

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3
Q

Growth velocity of the T1-L5 segment is fastest when?

A

the first 5 years of life

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4
Q

male:female ratio in IIS scoli

A

1:1

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5
Q

most common curve in INFANTILE IDIOPATHIC SCOLIOSIS

A

LEFT THORACIC

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6
Q

most important measure progression in IIS

A

apical rib-vertebral angle difference >20
or
overlap of the rib head with the apical vertebra

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7
Q

Juvenile IS male:female

A

female>male

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8
Q

most common curve in JUVENILE IDIOPATHIC SCOLI

A

RIGHT THORACIC

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9
Q

what percentage of JIS cases progress?

A

95% of cases

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10
Q

when to get an MRI for scoli

A

IIS - 22%have neural axis abnormality
JIS - 25% have neural axis abnormality
AIS - if left thoracic curve

short angular curves, absence of apical thoracic lordosis, absence of rotation, congenital scoli, hyperkyphosis

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11
Q

male to female ratio in AIS

A

in curves <30, 1:1 female to male
in curves >30, 10:1 female to male

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12
Q

who is at greatest risk of progression in AIS

A

girls
pre-menarchal
risser grade 0
tanner stage <3
open triradiate cartilage

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13
Q

what finding is commonly associated with non-rotational scoli curves and asymmetric abdominal reflexes?

A

syrinx

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14
Q

casting for infantile idiopathic scoli

A

can be curative for kids <18-24 months, and with a curve of <40-50deg

derotational casts applied in the OR and changed every 2-4 months for a total perior of 1year followed by bracing

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15
Q

IIS indications for bracing

A

RVAD >20, phase 2 rib-vertebra relationship, cobb >30degrees

curves <20degrees spontaneously resolve in the majority of patients

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16
Q

indications for bracing JIS and AIS

A

JIS: curves >20

AIS: curves >25 (risser 0,1,2 - bracing is ineffective after that)

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17
Q

tlso is most effective when apex vertebra is at what level?

A

T7 or distal

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18
Q

surgical indications for IIS and JIS

A

curves >50-70

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19
Q

surgical indication for AIS

A

thoracic curve >50
lumbar curve >45

marked trunk imbalance with curve >40

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20
Q

what is the effect of an incarcerated vertebra on the spine with regards to scoli progression

A
  • no scoli develops - deficiencies above and below compensate
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21
Q

failures of formation in congenital scoli

Study These Flashcards
A

wedge vertebra - mildest form

hemivertebrae
- can be
fully segmented - disk space present above nd below a hemivertebra
semisegmented - hemivertebra fused to a normal vertebra with disc on the other side
incarcerated - no scoli
nonsegmented - hemivertebra fused to vertebrae on both sides

22
Q

failures of segmentation in congenital scoli

Study These Flashcards
A

block vertebra - best prognosis
- bilateral bony bars

unilateral bar - bar is on concave side of scoli

unilateral bar, contralateral hemivertebrae - worst prognosis for progression (5-10deg/yr)

23
Q

workup of patients with congenital scoli should include what?

Study These Flashcards
A

renal
cardiac evals
spinal axis MRI

24
Q

treatment of unilateral bars

Study These Flashcards
A

early in situ arthrodesis

25
treatment of fully segmented hemivertebrae
in kids <5, curve <40 - in situ contralateral hemiepiphysiodesis with ipsilateral hemiarthrodesis in kids<6, curve <40 with marked trunk imbalance - hemivertebra excision
26
why dont you brace neuromuscular scoli kids?
bracing is ineffective at preventing curve progression, can cause skin issues, can contribute to GI and pulmonary issues
27
indications for scoli fusion in DMD?
earlier treatment - curves 20-30 before pulm compromise becomes an issue FVC <30% increases risk of prolonged post op mechanical ventilation
28
Scheuermann kyphosis
throacic hyperkyphosis with 3 consecutive vertebra with >5degree anterior vertebral wedging Male:female 4-7:1
29
natural history of scheuermann kyphosis
back pain that only rarely interferes with ADLs, mean curvature 71deg
30
what degree of curvature for scoli and kyphosis causes pulm compromise
>60 deg causes measurable pulm compromise, but >90 causes clinically significant for scoli >100 degrees kyphosis necessary for pulm compromise
31
radiographic features of scheuermann kyphosis
vertebral end plate anomalies loss of disc height schmorl nodes wedge vertebra need an MRI in all cases of congenital scoli
32
choosing fusion levels in kyphosis correction
limit correction to 50% of deformity to prevent proximal or distal junctional kyphosis, hardware pullout end vertebra or one proximal to end vertebra should be the proximal level lowest instrumented vertebra should be the sagittal stable vertebra
33
neurologic injury post correction is most common in what kind of scoli surgery?
kyphosis correction - thought to be vascular stretch injury
34
artery of adamkiewicz is where
left side t11 (anywhere from t8-l2)
35
spondylolysis
stress fracture thru pars interarticularis
36
spondylolisthesis
anterior slippage of the superior vertebra on the inferior vertebra L5 most common
37
associated conditions in spondylolisthesis
hamstring tightness paraspinal muscle spasm
38
nerve roots affected in spondylolisthesis
degenerative spondy (L4 on L5) -> traversing nerve root -> L5 isthmic spondy (L5 fracture -> L5 on S1) -> exiting nerve root 2/2 fracture callous -> L5
39
in down syndrom what is the most common cervical abnormality?
atlano-occipital hypermobility/instability subaxial spine is not involved in down syndrome occiput to C2 fusion should be performed when ADI>5mm +neuro sx, or ADI >10mm asx
40
Klippel feil syndrome
congenital cervical fusion - basilar invagination - short broad neck with a low hairline 1/3 will have sprengels deformity (high riding scapula)
41
Atlanto dens interval is used for diagnosing what condition?
atlanto axilal instabiilty ADI>5mm = AAI (normal in adults is 2-3mm but in kids up to 5mm is normal)
42
Powers ratio is used for diagnosing what condition?
atlantoaxial instability normal <1
43
atlantoaxial rotatory displacement
most common after a upper respiratory viral illness can range from mild displacement to fixed subluxation of c1 on c2 treatment: NSAIDs and soft collar if low grade if lasts >1 week: - reducible - head halter traction if lasts >1mo: halo C1-2 fusion if neuro sx or persistent deformity
44
Morquio syndrome is characterized by what spinal abnormalities?
atlantoaxial instability 2/2 odontoid hypoplasia tx for morquio syndrome and SED >5mm instability regardless of sx
45
most common complication of anterior pin in halo traction
supraorbital nerve kids get MORE pins (like 6-12) with less torque (<5lb-in)
46
most common nerve complication overall with halo traction
6th facial nerve palsy (abducens nerve) - unable to lateral gaze
47
pseudosubluxation is a common pedi cervical spine finding at what level?
C2-3, less commonly C3-4 must reduce on extension XR subluxation does not exceed 1.5mm
48
difference in diagnosis adult and child discitis?
blood cultures before abx, but you do not need a ct biopsy in kids, just treat presumptively for staph with 7-10 days IV vanc then oral for several weeks if not gettin better then do culture
49
cervical disc calcification
treatment is observation resolves within 1 month
50
anterior spine lesions
langerhans cell histiocytosis -> vertebra plana hemangioma (vertebral body vertical striations)
51
posterior element tumors
osteoid osteoma (Do not do radioablation in the spine 2/2 neuro risk) osteoblastoma (surgery is always indicated) aneurysmal bone cyst

AAOS Section 10 - Pediatrics (12 decks)

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