Ch 6 Spine Pathology Flashcards by Sarah Anderson

List 2 normal spine variants?

Filar cyst + ventriculus terminalis

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Main difference b/w a filar cyst + ventriculus terminalis?

Filar: inferior to conus
Ventriculus: within conus

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What is a filar cyst?

Anechoic structure within filum terminale, just inferior to conus medullaris

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What is ventriculus terminalis?

-Widening of the distal central canal, located within conus
-Typically resolves within first few months of life

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Another name for ventriculus terminalis?

5th ventricle or persistent terminal ventricle

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What is spinal dysraphism + what causes it?

Broad group of spinal abnormalities due to improper fusion of the neural tube during fetal development

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Where are spinal dysraphism defects m/c located?

Lower spine

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When is the neural tube finished developing?

8th week gestation

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The neural tube is formed by the closure of the ___?

Neural plate

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Should a normal neural plate completely fuse?

Yes! Or else dysraphism occurs

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Differentiate b/w open + closed spinal dysraphism?

Open:
-aka spina bifida aperta
-no skin covering sac
-neural tissue communicates with outside via defect

Closed: (harder to see)
-aka spina bifida occulta
-skin covered abnormality

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Differentiate b/w a meningocele, myelomeningocele + myelocele?

Meningocele:
-protrusion of meninges w/o neural tissue
-closed defect

Myelomeningocele:
-protrusion of meninges + neural tissue
-bulge above skin
-open defect

Myelocele:
-exposed neural tissue flush with skin surface + has no skin or meninges covering spinal cord
-open defect

(myelo = neural tissue, meningo = meninges)

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List the 2 types of open spinal dysraphism?

Myelocele + myelomeningocele (visible on outside of skin)

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Myeloceles + myelomeningoceles are herniation’s through a defect in the ___ mater?

Dura

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What is the m/c open spinal dysraphism?

Myelomeningocele

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With open spinal dysraphism, the spinal cord is ___ at the level of the abnormality?

Tethered

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List 3 complications of open spinal dysraphism?

-Decreased lower limb function to paralysis
-Bladder + bowel dysfunction
-Hydrocephalus

(similar complications to closed spinal dysraphism)

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___ occurs due to an enlarged subarachnoid space?

Myelomeningocele

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SF’s of open spinal dysraphism?

-Loss of normal conus
-Fluid filled sac
-Mass continuous with spinal canal

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Closed spinal dysraphism is present with skin-covered ___ or ___?

Subcutaneous mass or various skin markers

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List 2 subcutaneous masses associated with closed spinal dysraphism?

Lipomyelocele/lipomyelomeningocele + myelocystocele

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List the m/c skin marker associated with closed spinal dysraphism?

Sacral dimples

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Closed spinal dysraphism anomalies are associated with a ___?

Tethered cord

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Tethered cord is a type of ___?

Closed spinal dysraphism

What is a tethered cord?

Low lying cord with a thickened filum terminale

What happens as the spinal column grows + tethering occurs?

Causes stretching of spinal cord + limits its movement

Tethered cord is almost always associated with ___ anomalies?

Dysraphic spinal

Tethered cord symptoms are similar to OSD/CSD but may present earlier or later on?

Later on - as the child grows the spinal cord gets pulled tight, causing neurological symptoms

What 5 anomalies are highly suspicious for a spinal abnormality?

-Hair tufts -Vascular malformations -Deep dimples -Skin tags -Deep clefts (especially in lumbar region)

Tethered cord has a high association with ___ syndrome?

VACTERL

4 main SF's of a tethered cord?

-Conus is at or below L3 -Decreased movement of filum terminale + nerve roots (cauda equina) -Filum terminale will be thick (>2mm) or fatty -Conus looks abnormally elongated + lack normal tapering

What is diastomyelia?

-Longitudinal split of the spinal cord into 2 hemicords (usually reunites to form single distal cord) -Aka split cord malformation

Where does diastomyelia m/c occur?

In thoracolumbar region

Tethered cord, scoliosis, clubfoot, vertebral anomalies + dilation of the central canal is associated with ___?

Diastomyelia

Diastomyelia is diagnosed in what plane?

TRV (b/c 2 hemicords will be seen in this plane)

What is a dorsal dermal sinus?

-Thin epithelial lined tract that courses from skin towards spinal canal -Focal disruption of fusion of spinal canal

Dorsal dermal sinuses m/c occur where?

In lumbosacral region

Dorsal dermal sinuses clinically appear as deep midline ___?

Dimples/pits

What is the main SF of a dorsal dermal sinus?

Midline tract from spinal cord to skin (m/c in area of a skin marker/abnormality)

___ is the m/c reason an infant is referred for a spinal u/s?

Sacral dimple (located <2.5mm from anus)

Sacral dimples can be associated with a ___ sinus?

Pilonidal sinus (this has no connection to the normal spine)

What is a spinal lipoma?

Collections of encapsulated fat/connective tissue with a definite connection to the spinal cord (accounts for 20-50% of closed spinal defects)

Name the 3 types of spinal lipomas?

-Lipomyelocele/lipomyelomeningocele (m/c) -Intradural lipoma -Lipomas of filum terminale

What is the m/c spinal lipoma?

Lipomyelocele/lipomyelomeningocele

What is a lipomyelocele/lipomyelomeningocele?

-Skin covered echogenic fatty back mass that distorts + tethers the spinal cord -M/c in lumbar region

How do intradural lipomas + lipomas of the filum terminale differ from lipomyeloceles/lipomyelomeningoceles?

They do not have an associated subcutaneous mass

What is an intradural lipoma?

Mass within spinal cord that is completely confined by the dura

What is a lipoma of the filum terminale?

-Small echogenic fatty mass in filum -Filum thickens (>2mm)

What is a terminal myelocystocele?

-Skin covered cystic lumbar mass protruding through a dysraphic defect -Abnormal dilatation of the terminal ventricle that communicates with the central spinal cord

What is a block vertebrae?

When 2 adjacent vertebral bodies fail to separate

What is a hemivertebrae?

Congenital lack of formation of one half of a vertebral body

What is a butterfly vertebrae?

Cleft/failure of fusion of the lateral halves of the vertebral body

What is the m/c type of germ cell tumour occuring in the neonatal period?

Sacrococcygeal teratoma

What is a sacrococcygeal teratoma?

Benign sacral mass (risk of malignancy)

Birth trauma is m/c assessed with what imaging modality?

MRI

___ is performed on infants with sepsis to obtain CSF for culture?

Lumbar punctures

How does the appearance of hematomas vary with age?

Initially: echogenic Later on: anechoic as it resolves

Filum terminale is considered thick beyond what value?

2mm

How does a myelocele differ from a myelomeningocele?

Myelocele is flushed to skin with no meninges/skin covering it