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Flashcards in DISORDERS OF THE SPINE Deck (39):
1

What is back pain in infants and pre-adolescent children usually indicative of?

Connective tissue disorder

Scoliosis

Torticollis (if in the neck)

2

What is the main cause of back muscle spasm or soft tissue pain in an adolescent?

Sports injury

3

What are the differentials for back pain in an adolescent?

Sports injury

Scheuermann's disease

Spondylolysis

Spondylolisthesis

Vertebral osteomyelitis or discitis

Tumours

Scoliosis

Spina bifida

Idiopathic

4

What is the aetiology of Scheuermann's disease?

Considered part of osteochondrosis family. This means that it is characterised by avascular necrosis to the epiphysis and later regrowth of the bone.

5

What are the clinical features of Scheuermann's disease?

Marked lower kyphosis in thoracic spine (at least 3 vertebrae must be involved)

Pain

Stiffness

6

What will x-ray of someone with Scheuermann's disease show?

Epiphyseal plate disturbance

Anterior wedging

7

How do we treat Scheuermann's disease?

Mild cases: Physio and analgesia

More severe cases: Bracing and surgical stabilisation

8

What is the aetiology of spondylolysis?

Congenital or acquired deficiency (defect or stress fracture) of the pars interarticularis of the neural arch of of a particular vertebral body.

9

What are the vertebrae most commonly affected by spondylolysis?

L4/L5

Almost always lumbar

10

What proportion of the population are affected by a degree of spondylolysis?

Up to 5%, most cases are asymptomatic and therefore do not require treatment

11

What is the main risk factor for acquired spondylolysis in adolescents?

Over-training causing a stress fracture eg during a landing in ice dance

12

What are the clinical features of spondylolysis?

Unilateral back pain

Pain may radiate to buttocks or legs

Restricts daily activities

Worsens with strenuous activity and lumbar hyperextension

Pain on completion of stork test - see next slide

Unilateral tenderness on palpation

13

What is the stork test?

Patient stands on one foot and then lumbar spine is extended and rotated by examiner arching them backwards

14

What imaging should be done for someone with signs and symptoms consistent with spondylolysis?

X-ray

CT or MRI

Bone scintigraphy

15

What is the gold standard in terms of imaging and diagnosing spondylolysis?

Bone scintigraphy

16

How do we manage symptomatic spondylolysis?

Activity restriction

Abdominal exercise to increase core strength and stabilise spine

Bracing - Boston brace - most common treatment of acute spondylolysis

Surgery - used especially if condition progresses to high grade spondylolisthesis

17

What is the aetiology of spondylolisthesis?

Displacement (normally anteriorly) of one vertebra relative to its immediately inferior vertebral body

18

What is the most common cause of spondylolisthesis in adolescents?

Spondylolysis

19

Is spondylolisthesis the same as a slipped disc?

No. A slipped disc is more correctly termed a spinal disc herniation and refers to when one of the discs in between the vertebrae has ruptured. This is not the case in spondylolisthesis where the vertebrae itself has moved.

20

Where is the spine is spondylolisthesis most commonly found?

Lumbar spine

21

What are the clinical features of spondylolisthesis?

Generalised lower back pain - intensified on sneezing or coughing

Stiffening of the back

Leaning forwards (kyphotic) posture - compensatory change

Waddling gait

22

What is the radiological sign associated with traumatic spondylolisthesis?

Scotty dog appearance

23

How do we manage someone with spondylolisthesis?

Mild: Physio and analgesia

More severe: surgery (spondylolisthesis with spinal stenosis is one of the most common indications for spine surgery (laminectomy) among older adults)

24

What is vertebral osteomyelitis?

Infection of the vertebral body

25

What are the clinical features of vertebral osteomyelitis or discitis?

Severe pain on weight bearing and walking

Local tenderness

Known for subtleness in onset

Fever

Swelling at joint

More advanced disease will present with muscle spasm

26

What are the organisms that most commonly cause vertebral osteomyelitis?

Staph aureus - can be MRSA

Streptococcus equisimilis

27

In addition to imaging, what investigation might you do for someone in whom you suspect vertebral osteomyelitis?

Fine needle aspiration

28

How do we manage vertebral osteomyelitis?

IV antibiotics for weeks to months

If severe or unresponsive to antibiotics surgery may be indicated for debridement and spinal fusion

29

What is scoliosis?

Lateral curvature of the spine associated with rotational deformity.

30

What percentage of children are affected by scoliosis?

4%

31

What are the causes of scoliosis in children?

About 65% are idiopathic - adolescent idiopathic scoliosis (AIS)

Vertebral abnormalities:
Hemivertebra
Osteogenesis imperfecta
Spina bifida

Neuromuscular disorders:
Polio
Cerebral palsy
Muscular dystrophy

Other:
Dysmorphic syndromes such as neurofibromatosis, Marfan syndrome, Prader-Willi syndrome and CHARGE syndrome

32

Is scoliosis more common in boys or girls?

Girls

33

What are the clinical features of idiopathic scoliosis?

Pain - not always a typical feature in childhood

Lateral curvature of the spine on inspection

Rotation of thoracic spine on flexion

Rib hump (prominent shoulder blade) on bending forwards

34

What are the possible complications of scoliosis?

Diminished lung capacity

Pressure exerted on heart

Constipation due to tightened organs from curvature

Untreated severe disease will result in later degenerative changes, pain and unwanted cosmetic appearance

35

How do we manage scoliosis?

Mild cases: not treated

Moderate: braced for 23 hours a day until growing has stopped

Severe (more than 40˚): requires surgery that fuses the spine and therefore termination further growth

36

What is the more common name for acute torticollis?

Wry neck

37

What is wry neck or acute torticollis often associated with in children?

Upper respiratory tract infection

38

What is the most common cause of torticollis in children?

Sternomastoid tumour found in the first few weeks of life

39

How do we treat torticollis?

The disease is self limiting and should be managed with analgesia.

If the cause is a sternomastoid tumour, physio and stretching should be encouraged. It will usually resolve within the 1st year of life.

Surgery is reserved for persistent cases.