Module 11.1 : Spinal Pathology Flashcards

1
Q

Development of spine

A
  • each vertebrae develop from 3 ossification centers
    • centrum
    • neural processes
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2
Q

What does the centrum form

A
  • central portion of vertebral body
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3
Q

What does the neural processes form

A
  • pedicles
  • transverse processes
  • laminae
  • spinous process
  • posterolateral part of vertebral body
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4
Q

Ossification

A
  • ossification is not complete in than laminae until 18 weeks
  • can potentially miss a small spina bifida before the
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5
Q

Risk of NTD increase with

A
  • valproic acid (meds for seizures)
  • maternal diabetes
    + type 1 or 2
  • folic acid deficiency
  • history of spinal defects
    + previous pregnancy
    + family history
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6
Q

Spina bifida

A
- defect in bones structure of spinal canal that may result in Bernita ion of its content 
  \+ meninges 
   \+ CSF
   \+ neural tissue
- neural tube defect (NTD)
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7
Q

Other NTD

A
  • encephalocele
    + brain herniation
  • anencephaly
    + missing all = brain and and skull
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8
Q

Variations of spina bifida

A

Spina bifida occulta

Spina bifida Alperta

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9
Q

Spina bifida Occulta

A
  • involves only the deeper layers
  • may only see a skin dimple or patch of hair on the skin
  • closed defect
  • less common
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10
Q

Spina bifida aperta

A
  • involves all layers from dura to skin
  • open defect
  • more often
  • two types
    + meningocele
    + myelomeningocele
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11
Q

Spina bifida aperta - meningocele

A
  • contains meninges and CSF
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12
Q

Spina bifida aperta - myelomeningocele

A
  • contains meninges, CSF, and neural tissue

- more common

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13
Q

Screening for NTD

A
  • quad screen at 16 weeks
  • maternal serum alpha fetal protein
  • AFP produced by liver
  • crosses placenta and varies with gestational age
  • AFP is elevated with NTD not covered by skin
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14
Q

Other causes of elevated AFP

A
- abdominal wall defects
  \+ omphalocele
  \+ gastrodchisis (bowel outside)
- twins
- fetal death
- urinary obstruction
- cystic hygroma
- incorrect dates
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15
Q

NTD in lumbar spine

A
- Meckel Gruber syndrome
   \+ encephalocele
   \+ polycystic kidneys
   \+ polydactyly
- T18
- triploidy
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16
Q

What is a neural tube defect

A
- spinal dysgraphism 
   \+ abnormal closure of spine
- rachischisis
   \+ another name for spinal dysraphism
   \+ failure of fusion of vertebral arches
17
Q

Other system affected by NTD

A
  • legs
    + club foot
    + hip dislocation (not seen on US)
  • causes by imbalance of muscular activity due to nerve involvement of NTD
  • nerves exposed to amniotic fluid get damages
18
Q

Spinal NTD on US

A
  • splayed laminae
  • protruding mass or cyst
  • look for associated Arnold Chiari II and ventriculomegaly
19
Q

What plane is assessment on spine done best in

A

Transverse

20
Q

Prognosis of NTD

A
  • depends on location and extent of neural tissue involved

- more superior the worse off

21
Q

Ineincephaly

A
  • special case of dyraphism involving back of cranium and c spine
  • Inein refers to name of neck
  • segmentation errors of upper spine shortens neck and head becomes drosifelxed
  • known as star gazing position
  • associated with anencephaly
  • hydrocephaly ventricle not draining
22
Q

Scoliosis

A
  • lateral curvature of spine
23
Q

Kyphosis

A
  • exaggerates curvature of spine in sagittal Plane
24
Q

Scoliosis and kyphosis associated with

A
  • amniotic band syndrome
  • skeletal dysplasia
  • VACTERL
  • caudal regression syndrome
25
Q

VACTERL sequence

A
  • Vertebral (dysraphism)
  • Anal (atresia)
  • Cardiovascular
  • Tacheo-Esophageal (fistula or atresia)
  • renal
  • Limb (radial Ray)

+ get echo and look at kidneys

  • associated with caudal regression
  • prognosis depends on severity and extent of involvement
26
Q

Caudal regression

A
  • range of abnormalities of the spine
    + absence of part of sacrum up to absence of lumbar spine
  • increased risk with
    + type 1 maternal diabetes and insulin dependant diabetes (IDDM)
27
Q

Sirenomelia (mermaid syndrome)

A
  • absence of sacrum
  • fusion of legs
  • re tail atresia
  • renal dysgenisis or agenisis
  • oligohydroamnious (no kidneys no urine)
  • prognosis = all die in infancy
  • MOST SEVERE CAUDAL REGRESSION
28
Q

Sacroccygeal teratoma

A
  • contains elements of many tissue
  • teratomas can arise from sacrum or coccyx the brain or gonads
  • 4 types
29
Q

4 types of teratomas

A
  • I external mass predominant (most common)
  • II external mass with internal components (nest common)
  • III internal mass predominant with smaller external component (least common)
  • IV presacral mass (internal only) (second least common)
30
Q

Teratomas on US

A
  • mass on rum area adjacent to spine
  • most are solid or mixed = malignant
  • cystic = benign
  • May see calcification
  • displaces pelvic structures may compress ureters = hydronephrosis
  • if AV shunting May see heart failure
31
Q

Teratoma prognosis

A
  • depends on size of mass and severity of structure displacement
  • solid mass more malignant
  • if > 4.5 cm cesarean done
  • DDx = rectal duplication, anterior myelomeningocele, or sarcoma