Module 11.1 : Spinal Pathology Flashcards Preview

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Flashcards in Module 11.1 : Spinal Pathology Deck (31)
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1

Development of spine

- each vertebrae develop from 3 ossification centers
- centrum
- neural processes

2

What does the centrum form

- central portion of vertebral body

3

What does the neural processes form

- pedicles
- transverse processes
- laminae
- spinous process
- posterolateral part of vertebral body

4

Ossification

- ossification is not complete in than laminae until 18 weeks
- can potentially miss a small spina bifida before the

5

Risk of NTD increase with

- valproic acid (meds for seizures)
- maternal diabetes
+ type 1 or 2
- folic acid deficiency
- history of spinal defects
+ previous pregnancy
+ family history

6

Spina bifida

- defect in bones structure of spinal canal that may result in Bernita ion of its content
+ meninges
+ CSF
+ neural tissue
- neural tube defect (NTD)

7

Other NTD

- encephalocele
+ brain herniation
- anencephaly
+ missing all = brain and and skull

8

Variations of spina bifida

Spina bifida occulta
Spina bifida Alperta

9

Spina bifida Occulta

- involves only the deeper layers
- may only see a skin dimple or patch of hair on the skin
- closed defect
- less common

10

Spina bifida aperta

- involves all layers from dura to skin
- open defect
- more often
- two types
+ meningocele
+ myelomeningocele

11

Spina bifida aperta - meningocele

- contains meninges and CSF

12

Spina bifida aperta - myelomeningocele

- contains meninges, CSF, and neural tissue
- more common

13

Screening for NTD

- quad screen at 16 weeks
- maternal serum alpha fetal protein
- AFP produced by liver
- crosses placenta and varies with gestational age
- AFP is elevated with NTD not covered by skin

14

Other causes of elevated AFP

- abdominal wall defects
+ omphalocele
+ gastrodchisis (bowel outside)
- twins
- fetal death
- urinary obstruction
- cystic hygroma
- incorrect dates

15

NTD in lumbar spine

- Meckel Gruber syndrome
+ encephalocele
+ polycystic kidneys
+ polydactyly
- T18
- triploidy

16

What is a neural tube defect

- spinal dysgraphism
+ abnormal closure of spine
- rachischisis
+ another name for spinal dysraphism
+ failure of fusion of vertebral arches

17

Other system affected by NTD

- legs
+ club foot
+ hip dislocation (not seen on US)
- causes by imbalance of muscular activity due to nerve involvement of NTD
- nerves exposed to amniotic fluid get damages

18

Spinal NTD on US

- splayed laminae
- protruding mass or cyst
- look for associated Arnold Chiari II and ventriculomegaly

19

What plane is assessment on spine done best in

Transverse

20

Prognosis of NTD

- depends on location and extent of neural tissue involved
- more superior the worse off

21

Ineincephaly

- special case of dyraphism involving back of cranium and c spine
- Inein refers to name of neck
- segmentation errors of upper spine shortens neck and head becomes drosifelxed
- known as star gazing position
- associated with anencephaly
- hydrocephaly ventricle not draining

22

Scoliosis

- lateral curvature of spine

23

Kyphosis

- exaggerates curvature of spine in sagittal Plane

24

Scoliosis and kyphosis associated with

- amniotic band syndrome
- skeletal dysplasia
- VACTERL
- caudal regression syndrome

25

VACTERL sequence

- Vertebral (dysraphism)
- Anal (atresia)
- Cardiovascular
- Tacheo-Esophageal (fistula or atresia)
- renal
- Limb (radial Ray)

+ get echo and look at kidneys
- associated with caudal regression
- prognosis depends on severity and extent of involvement

26

Caudal regression

- range of abnormalities of the spine
+ absence of part of sacrum up to absence of lumbar spine
- increased risk with
+ type 1 maternal diabetes and insulin dependant diabetes (IDDM)

27

Sirenomelia (mermaid syndrome)

- absence of sacrum
- fusion of legs
- re tail atresia
- renal dysgenisis or agenisis
- oligohydroamnious (no kidneys no urine)
- prognosis = all die in infancy
- MOST SEVERE CAUDAL REGRESSION

28

Sacroccygeal teratoma

- contains elements of many tissue
- teratomas can arise from sacrum or coccyx the brain or gonads
- 4 types

29

4 types of teratomas

- I external mass predominant (most common)
- II external mass with internal components (nest common)
- III internal mass predominant with smaller external component (least common)
- IV presacral mass (internal only) (second least common)

30

Teratomas on US

- mass on rum area adjacent to spine
- most are solid or mixed = malignant
- cystic = benign
- May see calcification
- displaces pelvic structures may compress ureters = hydronephrosis
- if AV shunting May see heart failure