15.11.4 Paediatric Spinal Deformaties Flashcards
Mimickers of Lumbar Radiculopathy
Musculoskeletal: hip and pelvic pathology
- Osteoarthritis
- Osteonecrosis
- Femoral acetabular impingement
- Stress fractures
- Greater trochanteric bursitis
- Insufficiency fractures
- Sacroiliac joints
Vascular
Tumors
Peripheral neuropathy
- Metabolic
Compressive
Infectious and autoimmune disorders
- Pyogenic
- Shingles
- Guillain-Barré syndrome
- Transverse myelitis
latrogenic
- Myogenic
- Neuropathic
Red flags for serious spinal pathology
- thoracic pain
- fever and unexplained weight loss
- bladder and bowel dysfunction
- history of carcinoma
- ill health or presence of other medical illness
- progressive neurological deficit
- disturbed
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Define spinal deformities
- Scoliosis
- Kyphosis
- any spinal deformity more than 90degrees associated with cardiopul dysfunction (cur pulmonale, right heart fail)
- 60 degree = impairment of cardiopul
Scheuremann’s Kyphosis
- hypotic deformity
- Diagnosis: min of 3 adjacent vertebra that is compressing
- cosmetic and back pain issue
- as pt undergo grow spurt, they notice the deformity (back pain, can’t do sport)
Congenital scoliosis
Def
Aetiology
Classification
Rate of progession
Associated anomalities
Def
- Abnormal curvature of spine resulting from anomalous vertebral development
- Often not diagnosed @ birth
- More evident – progression with growth
- 80% of infants with scoliosis due to congenital scoliosis
Aetiology
Multifactorial
- Intra-uterine environmental factors
- Hypoxia during first 2/12 of gestation
- Foetal exposure to:
➡️Thalidomide
➡️Levostatin
➡️Certain progesterone / oestrogen compounds
* Genetic factors (less commonly)*
- Jarcho-Levin syndrome
- Spondylocostal dysostosis
- Klippel-Feil syndrome
Classification
- Descriptive (Location)
- Failure of formation, -segmentation, or both (McMaster)
Rate of progression
- age
- location of curve
- type of anomaly
Associated anomalities
- 30-60%
- Genitourinary tract
- Cardiac system
- Spinal cord (most common)
- VACTREL
VACTREL
Vertebral anomalies
Imperforate anus
Cardiac abnormalities
Tracheo-oesophageal fistula
Renal dysplasia
Limb malformations
Slide 14-21
Idiopathic scoliosis
Def
- includes axial plane deformities + includes rotation
- long curve
- abnormal rib hump
Def
- 3D structural deformity of the spine
- Apical rotation
- Wedging
- Greek word - crooked
Classification
- Infantile (0-3)
- Juvenile (4-9)
- Adolescent (10-18)
Slide 32
Infantile idiopathic scoliosis
- < 1% of all idiopathic scoliosis (US)
- US < Europe
- Males (3.5) > Females (1)
- Most curves = Left sided, mid- to low thoracic
- Large percentage of infantile curves resolve spontaneously
➡️33% (James et al. 1930) Resolving curves
Onset prior to age 1
No compensatory curves developed yet
➡️92% (Loyd-Roberts & Picher) - Girls with Right thoracic curve – worse prognosis
Idiopathic scoliosis
Aetiology
- Theories
Intra-uterine moulding (Browne)
• ??Notpresent@birth
Postnatal pressure on spine (supine positioning) (Mau)
Prone positioning associated – SIDS
Europe position infants supine (US – prone)
Higher rate of Infantile idiopathic scoliosis in Europe
Associated with
- Ipsilateral plagiocephaly
- Hip flattening
- Contractures of neck and feet
**Adolescent idiopathic scoliosis/ Late onset scoliosis **
Incidence
Etiology
Incidence
- In adolescents 2-3% curve < 10°
- Overall prevalence – equal between genders
- Def: Curves > 10° (4 Females : 1 male)
Etiology
- idiopathic
- Many theories:
Biomechanical point of view
– Euler’s law:
Pcrit=C(EI / LL)
– Pcrit = critical buckling load
– C = end condition
– E = young’s modulus (elasticity)
– I = cross sectional moment of inertia
– L = column length
• Etiology remains elusive
Neuromuscular scoliosis
- gentle c shaped curves
- hyper of hypotonic pt
Spondylolysis and Spondylolisthesis
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