Adolescent Spine (Guest Lecture) Flashcards
3 Common causes of general back pain in adolescents
- Growth and puberty
- Posture
- Over use (sports specific leading to mm imbalances, backpacks)
General Tx Outline for LBP
- Stretch what’s tight (flexibility)
- Strengthen what’s weak (core strength)
- Stabilize what’s imbalanced (posture)
- Modalities for pain
- Make it fun (for kids)
When it’s not just “back pain” - 8 conditions
- Spondylolysis/Spondylolysis
- Anterolisthesis
- Scoliosis
- Scheuermann’s Kyphosis
- Trauma
- Infection
- Neuromuscular
- Rheumatoid/AVN/Neoplasm
Condition: Starts as stress fx on the pars interarticularis, typically L5 followed by L4
Spondylolysis
Condition: Widening of the pars interarticularis fx with increased pain and radiculopathy
Spondylolisthesis
Non-Surgical Tx for Spondylolysis
- Active REST (stop sport but maintain CRF)
- Orthotics
- PT
Describe the difference between an anteriolisthesis and a retrolisthesis
Just indicates what moved and in which direction. Tx will be the same
Condition: side to side curvature of the spine (Cobb angle) of > 10 degrees
Idiopathic scoliosis (more common in females)
Sx of Idiopathic Scoliosis
- Pain
- Radiculopathy from neural tension
- Cardiopulmonary complications - effect of scoliosis on rib cage and rib functions
- Postural comepensation
Describe the Schroth Method
A method to correct spinal rotaiton and increased lung capactiy with rotational breathing
Describe how growing rods (Phenix) work to correct scoliosis in growing children
Either anterior or posterior rods are placed in the spine. Two rods threaded in opposite directions are connected with a magnetic component. 2 weeks after surgery the rods can be lengthened by rotation a magnet on the skin over the magnetic component in the spine.
Typically the are lengthened by 0.2 mm 5 out ot 7 days a week
Condition: Increased thoracic kyphosis with compensatory cervical and lumbar lordosis
Scheuermann’s Kyphosis
Condition: Compression fx to the vertebral body
Burst Fx
Condition: Transverse fx of the vertebral body right under the epiphysis, flexion and distraction fx
Chance Fx
Condition: Typically occurs in vertebrae from T12-L2
Chance fx
Describe how you would tx acute disc herniation in children compared to adults
Trick question: you tx them just like adults
Acute disc herniation in rare in children due to the strength of their connective tissues, however, when they do occur most are 12+ yo, most are also in L4-L5, L5-S1
Condition: also known as a limbus fx, caused by excessive compression or distraction and present like a disc herniation
Apophyseal ring fx
Can think of it as a salter harris fx to the growth plate in the vertebral body
4 Spine conditions caused by infection
- Vertebral osteomyelitis
- Septic arthritis
- Discitis
- Transient bacteremia (bacteria in blood)
Describe what you should consider in those pts. with sickle cell anemia
When in vaso-occlusive crisis they can present with localized back pain
Prolonged episodes of vaso-occlusive crisis can lead to bone and bone marrow infarction which has clear implications for the spine
Describe how Juvenile Anklyosis Spondylitis differs from Adult Anklyosis Spondylitis
While the adult condition typically begins at the SI joint and ascends in children the condition tyipcally begins in the peripheral joints
In children it typically take 4-8 yrs from sx onset to reach a dx
3 Themes from the Adolescent Spine Lecture
- Times of growth and the kinetic chain (Strength and Flexibility + Postural compensation = potential for problems)
- Address the imbalances (stretch the tight, strengthen the weak – this can change over course of tx)
- Education (age and sport/activity specific)
