Pediatric General Surgery Part 5 Flashcards
Scoliosis surgery is considered in all children with progressive curves greater than _____ to ______ degrees.
40 to 50 degrees
Define Scoliosis
Lateral deviation of the normal vertical spine greater than 10 degrees
Define Kyphosis
(Humpbacked) posterior angulation of the spine
Define Lordosis
(Bent backward) anterior angulation of the spine
Differentiate primary and secondary curves
- Primary curves: appear early and most frequently in thoracic and lumbar regions
- Secondary curves: (compensatory) develop above or below the primary curve and evolve to maintain alignment
What method is most commonly used to measure the magnitude of the curve from anteroposterior radiographs?
Cobb Method
What is congenital scoliosis caused by?
Spinal anomaly caused by failure of formation and segmentation that results in scoliosis or kyphosis (Hemivertebra is the most common cause)
Are bracing/casting effective for congenital scoliosis?
No
What are the surgical options for congenital scoliosis?
- Fusion
- Convex hemiepiphysiodesis
- Hemivertebra excision
- Growing rods
- Vertical expandable prosthetic titanium rib (VEPTR)
Infantile scoliosis occurs b/w what age?
Occurs b/w birth - 3 years old
Bracing for infantile scoliosis is considered when spine reaches _______ degrees
30 degrees
Treatment for infantile scoliosis starts as early as _______ months
4-5 months
Juvenile scoliosis is diagnosed b/w _________ and ________years
4-10 years
Juvenile scoliosis represents _________ % of idiopathic scoliosis
10-15%
What percentage of juvenile idiopathic scoliosis has an underlying spinal condition (i.e., Arnold Chiari Malformation)
20%
Juvenile Scoliosis > ________ degrees will require surgical intervention
30 degrees
Adolescent Idiopathic Scoliosis occurs after age _______.
10 years
Adolescent Scoliosis may have _________ impairment disproportionate to the severity of their scoliosis.
Pulmonary Impairment
Does bracing decrease curve progression in adolescent scoliosis?
- Bracing will decrease curve progression
- BUT bracing is associated with worse PFT results at the time of surgery.
What is neuromuscular scoliosis caused by?
- Caused by disorders of the brain, spinal cord, and muscular system
- Pts have deteriorating muscle function and mechanical distortion.
How does scoliosis affect the lungs?
↑ Restrictive lung defects
What problems can arise long term if scoliosis is untreated?
- Hypoxemia
- Hypercarbia
- Recurrent infections
- Pulmonary hypertension
What is the most significant predictor of impaired respiratory function for a scoliosis patient?
- The number of vertebrae affected
- Degree of thoracic curve
Scoliosis Surgery Anesthetic Management
- SSEP (Somatosensory evoked potentials)
- MEP (Motor evoked potentials)
- EMG (Electromyography)
- Pumps
- Bite block
- Foley Cath (long surgery)
- A-line
- 2 PIV
Define SSEP
Monitored from a peripheral nerve through dorsal column of spinal cord to somatosensory cortex. (Proprioception/Vibration)
Measures brain activity in response to sensory stimulation.
Define MEP
Monitored from a peripheral muscle through corticospinal tract to motor cortex
Measures muscle activity in response to motor cortex stimulation.
Define EMG
Direct nerve root monitoring (commonly during pedicle screw placement)
Measures the electrical activity of muscles at rest and during contraction, used to diagnose muscle and nerve disorders.
Evoked potential monitoring is affected by these factors.
- Neural injury
- VA
- Muscle relaxants
- Hypercbia
- Hypoxia
- Hypotension
- Hypothermia
How does scoliosis affect end-expiration and end-inspiration on the concave side?
How does scoliosis affect end-expiration and end-inspiration on the convex side?
