Neonatal Spine Flashcards
what gives the spine flexibility?
intervertebral disks
also create cushion and mobility
How many vertebrae are they?
33
7 cervical 12 thoracic 5 lumbar 5 sacral (fused) 4 coccygeal (fused)
What is the age limit for scanning the spine?
up to 6 months
3-4 months is ideal
Where does the spinal cord begin?
at the foramen magnum (base of the skull)
Where does the spinal cord terminate?
Upper border of L3
Lower border L1
Why do we check spinal cords in babies?
to find out where it ends
What is the lower tip of the spinal cord that comes to a point?
conus medullaris
What extends from conus to attach to the back of the coccyx?
filum terminale (long cord like thing)
What is the cauda equina?
lower nerve roots (look like fingers)
What is the single most important determination in doing a neonatal spine ultrasound?
the level of conus (ends above L2)
What is the lowest palpable rib bear vertebra?
L2
Where is the iliac crest?
L5
Where does the Thecal sac end?
about S2
What are the aspects of the normal spinal cord?
spinous processes
posterior arachnoid - dural layer (baby on stomach so posterior is first)
subarachnoid space
anterior margin of spinal cord
post margin of spinal cord
spinal cord (central echo complex)
What do the ribs do at the transverse thoracic level?
come straight out
what do the ribs do when scanning transverse lumbar?
ribs slant downward
What are some reasons for doing a scan?
midline hair patches
deep dimples
abnormal movement of the legs
pigmented nevi
fatty lumps
skin tags
hemangiomas
What are the different neural tube defects?
myelocele
myelomeningocele
intradural lipoma
lipomyelocele
lipomyelomeningocele
What is a tethered spinal cord?
Most common reason for a spinal sonogram
fixation of the cord in an abnormally caudal location
usually fixed eccentrically
cord oscillations may be decreased or absent near fixation
associated with imperforate anus
What is an imperforate anus?
no opening for the rectum
What is a lipoma?
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
What is hydromyelia?
dilatation of the central canal of the spinal cord with increased fluid in the cord
seen in variable degrees
What is diastematomyelia?
split cord by an osseous, cartilaginous or fibrous septum
one or more sites
seen well in trv
may rejoin caudally
vertebral column also abnormal
scan the entire spine always
What are the different cysts of the spinal cord?
small cysts of the filum terminale - not significant
in cauda equina region - may be seen with thick filum terminale
well margined within the filum terminale
What are the two kinds of spina bifida?
spina bifida occulta
spina bifida aperta
What is spina bifida occulta?
closed skin covered lesion
boney abnormality
seen on x ray
spinal lipoma or tethered cord
What is spina bifida aperta?
can be open or closed
myelomenigocele or menigocele
What is the difference between a myelomeningocele and a meningocele?
Myelomeningocele - contains cord and nerve roots. may be open or closed, but is usually open (aka: myeloschesis)
Meningocele - filled with cerebrospinal fluid. possibly strands of arachniod. usually covered by skin layer over sac
see slide 32 for picture.
What is myeloschisis?
open defect - no skin covering. completely open
aka: open myelomeningocele
What is a dermal sinus?
tract from skin surface to the distal thecal (dural) sac
may or may not be able to expel CSF
What is often seen just above site of tethering with Myelomeningocele or lipomyelomeningocele?
hydromyelia
