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Ortho - Pediatrics > Scoliosis > Flashcards

Flashcards in Scoliosis Deck (34)
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1

Definition of idiopathic adolescent scoliosis

Idiopathic scoliosis in kids 10-18 years old

2

Most common curve seen in idiopathic adolescent scoliosis?

Right thoracic. Left thoracic curves are rare and require MRI to rule out cyst or syrinx

3

Curvature associated with cardiopulmonary dysfunction and early death?

90 degrees

4

Risk factors for curve progression

> 25 degrees before skeletal maturity
> 50 thoracic or > 40 lumbar curve after skeletal maturity progresses at 1-2 degrees per year
lumbar
Double > single

5

Best predictor of curve progression

Peak growth velocity, if curve is > 30 degrees before this time they need surgery

6

When do girls typically reach skeletal maturity?

1.5 years after puberty

7

Classification systems

King-Moe and Lenke

8

Tool used in school screening exams

7 degree threshold on scoliometer

9

Physical exam

Adams forward bending, have patient sit if concerned limb length is causing curve.
Leg length, skin defects, shoulder height, truncal shift, rib prominence, pelvic tilt, cafe-au-lait spots, pes cavovarus, Hoffman, Babinski, clonus, sacral dimple/hair,

10

Radiographs

Cobb angle > 10 degrees in positive
Stable zone: vertical lines from lumbosacral facets
Stable vertebrae: most proximal vertebrae aligned centrally with central sacral vertical line
Neural vertebrae: spinous processes equidistant from pedicles on PA (not rotated)
Apical vertebrae: vertebra farther from center

11

Determining spine balance on plain radiographs in the coronal and sagittal planes

Coronal: C7 plumb to central sacral vertical line
Sagittal: C7 plumb to posterior and superior corner of S1

12

Indications for MRI

Atypical curve (left thoracic, short angular and atypical/excessive kyphosis)
Rapid progression
Neurologic symptoms
Foot deformity
Abnormal abdominal reflexes (T5-T12)

13

Indications for observation alone

Cobb angle

14

Indications for bracing (stops progression, doesn't reverse)

Cobb angle 25-45
Skeletally immature (Risser 0, 1, 2)

15

Patients with poor prognosis w/bracing

Poor correction w/brace
Hypokyphosis
Obese, male, non-compliant

16

Indications for posterior spinal fusion

Cobb angle > 45
Gold standard for thoracic & double major curves

17

Indications for anterior spinal fusion

Thoracolumbar and lumbar deformity with normal sagittal profile

18

Indications for anterior-posterior fusion

Curves > 75 degrees
Stiff curves
Risser grade 0, boys

19

Minimum requirement to wear brace to slow scoliosis progression

12 hrs/day

20

Definition of bracing failure

> 6 degrees or more of progression
Progression to > 45 degrees

21

Definition of skeletal maturity

Risser 4

22

If possible, always avoid fusion of what levels in posterior fusions for scoliosis?

L4-L5, increased incidence of back pain with L5 fusions

23

How to avoid crankshaft phenomenon

Perform anterior discectomy and fusion in patients that are very young and are undergoing posterior spinal fusion

24

Scoliosis surgery complications

Nerve injury, crankshaft phenomenon, SMA syndrome, infection, flat back syndrome and hardware failure.

25

Definition of juvenile idiopathic scoliosis

Onset between ages 4-10

26

Conditions associated with juvenile idiopathic scoliosis

Syringomyelia
Arnold-Chiari malformation
Tethered cord
Dysraphisms
Spinal cord tumors
Bowel/bladder dysgenesis

27

Infantile idiopathic scoliosis

Scoliosis in children less than 3

28

Infantile idiopathic scoliosis unusual epidemiological factors

Boys > girls, left curve > right curve, most resolve spontaneously

29

What spinal segment grows most rapidly in the 1st 5 years of life?

T1-L5

30

Rib vertebral angle difference (RVAD)

Measure between endplate and rib (line between midpoint of rib head and neck). Then take the difference from another angle. > 20 degrees = high rate of progression.