PEDS Spine

Question 1

EG in the Spine (vertebral body). Initial Mgmt?

Answer 1

Observation. Will reconstitute.

Question 2

Didn’t work. Now what?

Answer 2

Bracing.

Question 3

Good idea. Now expanding into canal on MR but no neuro signs. Ideas?

Answer 3

Steroid Injection.

Question 4

Perfect. Now neuro signs.

Answer 4

Decompression via surgery

Question 5

Name 2 Multi-focal EG Conditions

Answer 5

Hand-Schuller-Christian = visceral involvement.   Exophtalmos & DI.   AKA Langerhans Cell Histiocytosis
Letterer-Siwe = fatal form in very young.

Question 6

What causes (not trauma) AARI?

Answer 6

Ligamentous & capsular Laxity

Question 7

If AARI w/ abscess post URTI what is the name?

Answer 7

Grisel’s Syndrome.

Question 8

Who you gonna call?

Answer 8

ENT.

Question 9

Imaging in Grisel’s?

Answer 9

MRI > CT.

Question 10

Treatment options for AARI? (all types) list 4.

Answer 10

NSAIDS & Collar.

Traction.

Halo Vest

Fusion

Question 11

Scheurmann’s Kyphosis. Define it.

Answer 11

5 degrees of wedging in 3 consecutive levels.

Question 12

Scheurmann’s Kyphosis. 1e curve?

Answer 12

Thoracic Kyphosis

Question 13

Scheurmann’s Kyphosis. 2e curves? (2)

Answer 13

Cervical & Lumbar Lordosis

Question 14

DDx for Scheurmann’s Kyphosis. . 3

Answer 14

Postural Kyphosis.
Congenital Kyphosis
Tumour
Compression #
Skeletal Dysplasia

Question 15

Scheurmann’s Kyphosis. Cobb <60. Rx?

Answer 15

PT, Follow q6/12.

Question 16

Scheurmann’s Kyphosis. Cobb 60-80. Rx?

Answer 16

Brace if skeletal immaturity.

Question 17

Scheurmann’s Kyphosis. Cobb 80+. Rx?

Answer 17

Surgery

Question 18

Surgical Plan?

Answer 18

Anterior Release.
Pedicle Subtraction Osteotomy at Apex
Segmental Spinal Fixation

Question 19

Torticollis. Define it.

Answer 19

Head Tilt to one side.

Head turns to affected side.

Chin turns away from affected side.

SCM contracted.

Question 20

Torticollis. Ortho DDx. 2

Answer 20

AARI
Klippel Feil
Congenital

Question 21

Torticollis. Non-Ortho DDx. 2

Answer 21

Grisel’s

Tumour

Question 22

Torticollis - Imaging?

Answer 22

XR if no ST mass. Rule out AARI or KF.

US if mass.

Question 23

Torticollis - Treatment?

Answer 23

PT & Stretching.

90% respond within a yr.

Question 24

Torticollis - Surgical Rx?

Answer 24

Indications if 1yr+ or 30 degrees+ contracture. SCM Z plasty/release.

Question 25

Klippel-Feil. Define it.

Answer 25

Multiple abnormal C-Spine Segments. 3-8 wks in utero - cervical somite bodies.

Question 26

Klippel Feil Associations.

Answer 26

``` Webbed Neck. Low Hair Line. Big Jaw. Scoliosis. Sprengel's Synkinesis. Congenital Heart Issue Brainstem abnormality. AAI - 50% Cervical Stenosis ```

Question 27

Klippel Feil. Rx.

Answer 27

Observation, counsel to avoid neck at risk sports. Contact, flipping, gymnastics, etc.

Question 28

Klippel Feil. Surgery Indications

Answer 28

Basilar Invagination. Chronic Pain. Myelopathy. AARI. Adjacent level disease.

Question 29

Spondylolysis & Listhesis. Classify - (5)

Answer 29

``` Congenital (dysplastic) Isthmic Traumatic Neoplastic Degenerative ```

Question 30

Define Spondylolysis & Listhesis

Answer 30

Anatomic defect (gap) in the pars with adjacent sclerosis. Translation of one body on the next.

Question 31

What % of kids with lysis progress to listhesis?

Answer 31

15.

Question 32

Most common level in kids? in adults?

Answer 32

Kids. L5/S1. Adults. L4/5

Question 33

What is most likely to progress?

Answer 33

Larger Slip (grade) & dysplastic.

Question 34

How do you grade slip?

Answer 34

``` Myerding. 1 - <25% 2 - 25-50 3 - 50-75 4 - 75-100 5 - Spondyloptosis ```

Question 35

How to draw SLIP ANGLE?

Answer 35

``` Lateral view. 1st line up posterior sacrum. 2nd line at 90 to 1st line across S1. 3rd line parallel across L5 inferior endplate. angle between 2 & 3 is SLIP ANGLE. ```

Question 36

____ + _____ = ______ SS, PI, PT.

Answer 36

PI = PT + SS

Question 37

Indications for surgery?

Answer 37

Anyone Failed non-op or slip progressing. Activity break. TLSO 3mos. All Grade 3 or higher. Lysis - dysplastic. Low grade listhesis: prorgressive. neuro deficits dysplastic Very controversial for reduction.

Question 38

Define PT

Answer 38

Pelvic Tilt is the orientation of the sacrum relative to the femoral head. To Draw the angle, it is the angle between a vertical line from the centre of the femoral head and a second line from the femoral head to the middle of S1.

Question 39

Define SS

Answer 39

Sacral slope is the version of the S1 endplate. To measure, the S1 endplate off a horizontal line from posterior S1.

Question 40

Define PI

Answer 40

Pelvic Incidence is the combination of SS + PT. It can be measure by combining the two. It can be drawn as a line from the centre of the femoral head to the middle of S1 and measuring the 90 degree tangent from that.