Neonatal Spine

Question 0

anatomy of the spine consists of what

Answer 0

33 vertebrae

intervertebral disks - flexibility

Question 1

breakdown the 33 vertebrae’s

Answer 1

7 cervical
12 thoracic
5 lumbar
5 sacral (fused)
4 coccygeal (fused)

Question 2

where does the spinal cord begin

Answer 2

foramen magnum

Question 3

where does the spinal cord end

Answer 3

above level of upper border of L3 in the child

lower border of L1 in adults

Question 4

what is the conus medullaris

Answer 4

lower tip of cord

level of conus is single most important determination - usually ends above L2

lowest palpable rib bearing vertebra is L2

iliac crest is L5

thecal sac ends about S2

Question 5

what is the filum terminale

Answer 5

extends from conus to attach to the back of the coccyx

Question 6

what is the cauda equina

Answer 6

lower nerve roots

Question 7

what does the normal spinal cord consist of

KNOW PIC ON SLIDE 5

Answer 7

spinous processes
posterior arachnoid - dural layer
subarachnoid space
posterior margin of spinal cord
spinal cord (central echo complex)
anterior margin of spinal cord

Question 8

describe tethered spinal cord

Answer 8

MOST COMMON reason for spinal sonogram

fixation of the cord in an abn caudal location

usually fixed eccentrically

cord oscillations may be decreased or absent near fixation

associated with imperforate anus

Question 9

describe lipoma

Answer 9

mass of the lower cord or filum terminal

tethered cord associated with lipoma

echogenic fatty mass

may be continuous with a fatty lump in the lower back

Question 10

describe hydromyelia

Answer 10

dilatation of the central canal of the spinal cord with increased fluid in cord

can be seen in variable degrees

often seen just above site of tethering with myelomeningocele or lipomyelomenginocele

may also be present with diastematomyelia

Question 11

describe diastematomyelia

Answer 11

split cord by an osseous, cartilaginous or fibrous septum

one or more sites

seen well transverse

may rejoin caudally

vertebral column also abn

Question 12

describe cysts of the cord

Answer 12

small cysts of the filum terminale are of no significance

cysts in cauda equina region may be seen with a thick filum terminale

well marginated anechoic mass in filum terminale

Question 13

describe spina bifida occulta

Answer 13

closed skin covered lesion - boney abnormality - seen on x-ray - spinal lipoma or tethered cord

Question 14

describe spina bifida aperta

Answer 14

can be open or closed - myelomeningocele or meningocele - vertebral defects

Question 15

describe myelomeningocele

Answer 15

contains cord and nerve roots which may be open or closed, but usually is open (non skin covered)

also called open myeloschesis

Question 16

describe meningocele

Answer 16

filled with cerebrospinal fluid, possibly strands of arachnoid usually has skin layer over sac

Question 17

at what age are spinal cord US not done anymore

Answer 17

6 months

Question 18

myeloschisis is an ______ defect

Answer 18

open

Question 19

what are some external signs of cord abnormalities

Answer 19

midline sacral dimples 2-4% of newborns

   - most of no significance
   - may have a sinus tract to dura sac

midline hair pathces, fatty lumps, skin tags, pigmented nevi, dimple, hemangiomas - ALL are possible signs of abn’s

Question 20

describe dermal sinus

Answer 20

tract from skin surface to distal thecal sac

may or may not be able to expel CSF

Question 21

REVIEW ALL IMAGES ON POWERPOINT…

Answer 21

VERY IMPORTANT…