paeds- spine problems Flashcards
Scoliosis
lateral curvature of the spine (and also rotational deformity)
Any painful scoliosis warrants urgent investigation (MRI for tumour or infection).
Scoliosis causes
idiopathic (most common) or
secondary to neuromuscular disease
tumour (eg osteoid osteoma)
skeletal dysplasia
infection.
scoliosis risk factors
Idiopathic scoliosis is more common in females and presents in adolescence with concerns regarding cosmetic appearance.
Younger children with scoliosis usually have an underlying cause and may progress more readily to a severe curve.
Scoliosis investigation & treatment
Any painful scoliosis warrants urgent investigation (MRI for tumour or infection).
Mild, non‐progressive scoliosis (majority of cases) does not require surgery.
Larger curves may require surgery for cosmesis or to improve wheelchair posture (neuromuscular disease).
Severe curves can result in a restrictive lung defect and surgery may be required to prevent breathing difficulties.
Surgery is complex and requires vertebral fusions and long rods connecting the posterior elements of the spine.
Correction of larger curves carries a risk of spinal cord injury (intraoperative monitoring may be used).
Spondylolisthesis & risk factors
slippage of one vertebra over another and usually occurs at the L4/L5 or L5/S1 level.
It can be due to a developmental defect or a recurrent stress fracture of the posterior elements which fails to heal.
usually presents in adolescence.
Increased body weight and increased sporting activity have been implicated.
Spondylolisthesis Symptoms
Patients present with low back pain and may have a radiculopathy with severe slippage.
They may have a paradoxical “flat back” due to muscle spasm and can present acutely with a characteristic waddling gait.
Spondylolisthesis Treatment
Minor degrees of slippage may be observed and treated with rest & physiotherapy.
More severe slips may require stabilization and possibly reduction (however this risks neurological injury).
