Module 11.1 : Spinal Pathology Flashcards
(31 cards)
1
Q
Development of spine
A
- each vertebrae develop from 3 ossification centers
- centrum
- neural processes
2
Q
What does the centrum form
A
- central portion of vertebral body
3
Q
What does the neural processes form
A
- pedicles
- transverse processes
- laminae
- spinous process
- posterolateral part of vertebral body
4
Q
Ossification
A
- ossification is not complete in than laminae until 18 weeks
- can potentially miss a small spina bifida before the
5
Q
Risk of NTD increase with
A
- valproic acid (meds for seizures)
- maternal diabetes
+ type 1 or 2 - folic acid deficiency
- history of spinal defects
+ previous pregnancy
+ family history
6
Q
Spina bifida
A
- 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
Q
Other NTD
A
- encephalocele
+ brain herniation - anencephaly
+ missing all = brain and and skull
8
Q
Variations of spina bifida
A
Spina bifida occulta
Spina bifida Alperta
9
Q
Spina bifida Occulta
A
- involves only the deeper layers
- may only see a skin dimple or patch of hair on the skin
- closed defect
- less common
10
Q
Spina bifida aperta
A
- involves all layers from dura to skin
- open defect
- more often
- two types
+ meningocele
+ myelomeningocele
11
Q
Spina bifida aperta - meningocele
A
- contains meninges and CSF
12
Q
Spina bifida aperta - myelomeningocele
A
- contains meninges, CSF, and neural tissue
- more common
13
Q
Screening for NTD
A
- 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
Q
Other causes of elevated AFP
A
- abdominal wall defects \+ omphalocele \+ gastrodchisis (bowel outside) - twins - fetal death - urinary obstruction - cystic hygroma - incorrect dates
15
Q
NTD in lumbar spine
A
- Meckel Gruber syndrome \+ encephalocele \+ polycystic kidneys \+ polydactyly - T18 - triploidy
16
Q
What is a neural tube defect
A
- spinal dysgraphism \+ abnormal closure of spine - rachischisis \+ another name for spinal dysraphism \+ failure of fusion of vertebral arches
17
Q
Other system affected by NTD
A
- 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
Q
Spinal NTD on US
A
- splayed laminae
- protruding mass or cyst
- look for associated Arnold Chiari II and ventriculomegaly
19
Q
What plane is assessment on spine done best in
A
Transverse
20
Q
Prognosis of NTD
A
- depends on location and extent of neural tissue involved
- more superior the worse off
21
Q
Ineincephaly
A
- 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
Q
Scoliosis
A
- lateral curvature of spine
23
Q
Kyphosis
A
- exaggerates curvature of spine in sagittal Plane
24
Q
Scoliosis and kyphosis associated with
A
- 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
31
Teratoma prognosis
- depends on size of mass and severity of structure displacement
- solid mass more malignant
- if > 4.5 cm cesarean done
- DDx = rectal duplication, anterior myelomeningocele, or sarcoma
