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AAOS Section 10 - Pediatrics > Chapter 140 - Pediatric Spine > Flashcards

Chapter 140 - Pediatric Spine Flashcards

1
Q

normal thoracic kyphosis

A

20-45 degrees

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2
Q

normal lumbar lordosis

A

30-60

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3
Q

Growth velocity of the T1-L5 segment is fastest when?

A

the first 5 years of life

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4
Q

male:female ratio in IIS scoli

A

1:1

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5
Q

most common curve in INFANTILE IDIOPATHIC SCOLIOSIS

A

LEFT THORACIC

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6
Q

most important measure progression in IIS

A

apical rib-vertebral angle difference >20
or
overlap of the rib head with the apical vertebra

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7
Q

Juvenile IS male:female

A

female>male

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8
Q

most common curve in JUVENILE IDIOPATHIC SCOLI

A

RIGHT THORACIC

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9
Q

what percentage of JIS cases progress?

A

95% of cases

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10
Q

when to get an MRI for scoli

A

IIS - 22%have neural axis abnormality
JIS - 25% have neural axis abnormality
AIS - if left thoracic curve

short angular curves, absence of apical thoracic lordosis, absence of rotation, congenital scoli, hyperkyphosis

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11
Q

male to female ratio in AIS

A

in curves <30, 1:1 female to male
in curves >30, 10:1 female to male

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12
Q

who is at greatest risk of progression in AIS

A

girls
pre-menarchal
risser grade 0
tanner stage <3
open triradiate cartilage

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13
Q

what finding is commonly associated with non-rotational scoli curves and asymmetric abdominal reflexes?

A

syrinx

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14
Q

casting for infantile idiopathic scoli

A

can be curative for kids <18-24 months, and with a curve of <40-50deg

derotational casts applied in the OR and changed every 2-4 months for a total perior of 1year followed by bracing

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15
Q

IIS indications for bracing

A

RVAD >20, phase 2 rib-vertebra relationship, cobb >30degrees

curves <20degrees spontaneously resolve in the majority of patients

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16
Q

indications for bracing JIS and AIS

A

JIS: curves >20

AIS: curves >25 (risser 0,1,2 - bracing is ineffective after that)

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17
Q

tlso is most effective when apex vertebra is at what level?

A

T7 or distal

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18
Q

surgical indications for IIS and JIS

A

curves >50-70

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19
Q

surgical indication for AIS

A

thoracic curve >50
lumbar curve >45

marked trunk imbalance with curve >40

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20
Q

what is the effect of an incarcerated vertebra on the spine with regards to scoli progression

A
  • no scoli develops - deficiencies above and below compensate
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21
Q

failures of formation in congenital scoli

A

wedge vertebra - mildest form

hemivertebrae
- can be
fully segmented - disk space present above nd below a hemivertebra
semisegmented - hemivertebra fused to a normal vertebra with disc on the other side
incarcerated - no scoli
nonsegmented - hemivertebra fused to vertebrae on both sides

22
Q

failures of segmentation in congenital scoli

A

block vertebra - best prognosis
- bilateral bony bars

unilateral bar - bar is on concave side of scoli

unilateral bar, contralateral hemivertebrae - worst prognosis for progression (5-10deg/yr)

23
Q

workup of patients with congenital scoli should include what?

A

renal
cardiac evals
spinal axis MRI

24
Q

treatment of unilateral bars

A

early in situ arthrodesis

25
Q

treatment of fully segmented hemivertebrae

A

in kids <5, curve <40
- in situ contralateral hemiepiphysiodesis with ipsilateral hemiarthrodesis

in kids<6, curve <40 with marked trunk imbalance
- hemivertebra excision

26
Q

why dont you brace neuromuscular scoli kids?

A

bracing is ineffective at preventing curve progression, can cause skin issues, can contribute to GI and pulmonary issues

27
Q

indications for scoli fusion in DMD?

A

earlier treatment - curves 20-30 before pulm compromise becomes an issue

FVC <30% increases risk of prolonged post op mechanical ventilation

28
Q

Scheuermann kyphosis

A

throacic hyperkyphosis with 3 consecutive vertebra with >5degree anterior vertebral wedging
Male:female 4-7:1

29
Q

natural history of scheuermann kyphosis

A

back pain that only rarely interferes with ADLs, mean curvature 71deg

30
Q

what degree of curvature for scoli and kyphosis causes pulm compromise

A

> 60 deg causes measurable pulm compromise, but >90 causes clinically significant for scoli

> 100 degrees kyphosis necessary for pulm compromise

31
Q

radiographic features of scheuermann kyphosis

A

vertebral end plate anomalies
loss of disc height
schmorl nodes
wedge vertebra

need an MRI in all cases of congenital scoli

32
Q

choosing fusion levels in kyphosis correction

A

limit correction to 50% of deformity to prevent proximal or distal junctional kyphosis, hardware pullout

end vertebra or one proximal to end vertebra should be the proximal level

lowest instrumented vertebra should be the sagittal stable vertebra

33
Q

neurologic injury post correction is most common in what kind of scoli surgery?

A

kyphosis correction - thought to be vascular stretch injury

34
Q

artery of adamkiewicz is where

A

left side t11 (anywhere from t8-l2)

35
Q

spondylolysis

A

stress fracture thru pars interarticularis

36
Q

spondylolisthesis

A

anterior slippage of the superior vertebra on the inferior vertebra

L5 most common

37
Q

associated conditions in spondylolisthesis

A

hamstring tightness
paraspinal muscle spasm

38
Q

nerve roots affected in spondylolisthesis

A

degenerative spondy (L4 on L5) -> traversing nerve root -> L5

isthmic spondy (L5 fracture -> L5 on S1) -> exiting nerve root 2/2 fracture callous -> L5

39
Q

in down syndrom what is the most common cervical abnormality?

A

atlano-occipital hypermobility/instability

subaxial spine is not involved in down syndrome

occiput to C2 fusion should be performed when ADI>5mm +neuro sx, or ADI >10mm asx

40
Q

Klippel feil syndrome

A

congenital cervical fusion
- basilar invagination
- short broad neck with a low hairline
1/3 will have sprengels deformity (high riding scapula)

41
Q

Atlanto dens interval is used for diagnosing what condition?

A

atlanto axilal instabiilty

ADI>5mm = AAI (normal in adults is 2-3mm but in kids up to 5mm is normal)

42
Q

Powers ratio is used for diagnosing what condition?

A

atlantoaxial instability

normal <1

43
Q

atlantoaxial rotatory displacement

A

most common after a upper respiratory viral illness

can range from mild displacement to fixed subluxation of c1 on c2

treatment: NSAIDs and soft collar if low grade

if lasts >1 week:
- reducible - head halter traction

if lasts >1mo:
halo
C1-2 fusion if neuro sx or persistent deformity

44
Q

Morquio syndrome is characterized by what spinal abnormalities?

A

atlantoaxial instability 2/2 odontoid hypoplasia

tx for morquio syndrome and SED >5mm instability regardless of sx

45
Q

most common complication of anterior pin in halo traction

A

supraorbital nerve

kids get MORE pins (like 6-12) with less torque (<5lb-in)

46
Q

most common nerve complication overall with halo traction

A

6th facial nerve palsy (abducens nerve) - unable to lateral gaze

47
Q

pseudosubluxation is a common pedi cervical spine finding at what level?

A

C2-3, less commonly C3-4
must reduce on extension XR
subluxation does not exceed 1.5mm

48
Q

difference in diagnosis adult and child discitis?

A

blood cultures before abx, but you do not need a ct biopsy in kids, just treat presumptively for staph with 7-10 days IV vanc then oral for several weeks

if not gettin better then do culture

49
Q

cervical disc calcification

A

treatment is observation

resolves within 1 month

50
Q

anterior spine lesions

A

langerhans cell histiocytosis -> vertebra plana
hemangioma (vertebral body vertical striations)

51
Q

posterior element tumors

A

osteoid osteoma (Do not do radioablation in the spine 2/2 neuro risk)
osteoblastoma (surgery is always indicated)
aneurysmal bone cyst

AAOS Section 10 - Pediatrics (12 decks)

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