Paediatric Spine Problems

Question 1

what is scoliosis

Answer 1

lateral curvature of the spine (also rotational deformity)

Question 2

what causes scoliosis

Answer 2

idiopathic

or secondary to neuromuscular disease, tumour (osteoid osteoma), skeletal dysplasia or infection

Question 3

what theories have been proposed as to why idiopathic scoliosis occurs, what are they

Answer 3

heuter-volkmanns law = increased pressure across an epiphyseal plate inhibits growth
triangular spine concept (dickson) = primary defect is lordotic with secondary buckling
abnormality of trunk rotation with walking

Question 4

what if someone presents with painful scoliosis

Answer 4

urgent investigation ie MRI for tumour or infection

Question 5

how is scoliosis treated

Answer 5

mild (most cases) = nothing

larger curves = may require surgery for cosmesis or to improve wheelchair posture in neuromuscular disease

Question 6

what problems can severe scoliosis cause

Answer 6

restrictive lung defect

Question 7

what does scoliosis surgery involve

Answer 7

vertebral fusions and long rods connecting the posterior elements of spine
carries risk of spinal cord injury

Question 8

what is spondylolisthesis

Answer 8

slippage of one vertebra over another and usually occurs at the L4/5 or L5/S1 level

Question 9

what can be cause of spondylolisthesis

Answer 9

developmental defect or recurrent stress fracture of posterior elements which fails to heal
increased body weight and sporting activity have been implicated

Question 10

what are symptoms of spondylolisthesis

Answer 10

low back pain
may have radiculopathy with severe slippage
have paradoxical “flat back” due to muscle spasm and can present acutely with waddling gait

Question 11

how is minor spondylolisthesis treated

Answer 11

rest and physiotherapy

Question 12

how is more severe spondylolisthesis treated

Answer 12

stabilisation and possibly reduction (this risks neurological injury)

Question 13

how is spondylolisthesis graded

Answer 13

meyerding grading
grade 1 or 2 = abnormal neighbouring discs - posterolateral stabilisation in situ
grade 3 = combined discogenic + nerve root problem - one stage combined anterior and posterior stabilisation
grade 5 = spondyloptosis (100% subluxation of vertebra)

Question 14

what is spondylolysis

Answer 14

stress fracture - defect in the pars interarticularis of vertebra