Low Back Pain Child + Stenosis/Spondylolsithesis Flashcards
1
Q
What causes low back pain in children?
A
- Spondylolysis + Spondylolisthesis
- Disc prolapse
- Trauma
- Infections
- Inflammatory spondyloarthropathy
- Neoplasms
- Non accidental injury - scheuermann’s disease/ kyphosis, scoliosis
2
Q
What is pars defect (spondylolysis)?
A
- Most common cause of LBP in child
- Pars = between facet joint processes
- Thought to arise from repetitive hyperextension + pincer action of joint against pars
- Untreated spondylolysis > spondylolisthesis
3
Q
What is spondylolisthesis?
A
- Slippage of one bone on another (forward, backward or lateral of 1 vertebra relative to adjacent vertebra)
- LBP, buttock, thigh, groin pain
+/- radicular pain, numbness/weakness L5-S1 - Urinary bowel
- O/E = restricted motion, hyperlordosis, palpable step, kyphosis above, trunk short, rib on crests, tight hamstrings, L5-S1 neuro findings
4
Q
What is scoliosis?
A
= abnormal curve of spine in coronal plane
5
Q
What are the indications for surgery in scoliosis?
A
- Curve > 40 skeletally immature
- Curve > 50 skeletally mature
- Relentless curve progression
- Cardiopulmonary complications
- Functions
- Prevent neurological deteiroration
6
Q
What are the objective of scoliosis treatment?
A
- Prevent progression
- Permit longitudinal growth
- Avoid cardio-pulmonary complications
- Facilitate sitting + handling
- Levels shoulders + pelvis
- Centre of gravity over sacrum
7
Q
What are the causes of scoliosis?
A
Congenital, idiopathic or neuromuscular
8
Q
What is the test for scoliosis?
A
Adams test (forward bend test) = development of rib hump
9
Q
What is kyphosis?
A
= abnormal curvature of spine in sagittal plane
10
Q
What are the cause of kyphosis?
A
- Scheuermann’s
- Ankylosing spondylitis
- Neurofibromatosis
- Diastrophic dysplastic
- Turner/marfan/anchondroplasia syndrome
- Congenital
- Post laminectomy
- Post traumatic
- Infective
11
Q
What is scheuermann’s kyphosis?
A
- Rigid round back deformity adolescents
- aka 5 degree anterior wedding of 3 contiguous vertebral bodies
- Diagnosis made if end plate irregularities
- Associated with LBP
12
Q
What are the 2 types of scheuermann’s kyphosis?
A
- Thoracic
- Thoracolumbar
13
Q
What is claudication?
A
- Cramping pain in leg induced by exercise due to obstruction in arteries
- Limping
14
Q
What is stenosis?
A
- Narrowing of spinal canal, nerve root canals or tunnels of intervertebral foramina producing symptoms of claudication or radiculopathy
- Types = central, lateral recess + foraminal
15
Q
What is the commonest spondylolisthesis in young and elderly?
A
Young = Lytic L5/1 Elderly = Degenerative L4/5
