PEDIATRIC Section 14: Pediatric Spine Flashcards
Because the canal grows faster than the cord, a fixed attachment (“tethering”) results in cord stretching and subsequent ischemia.
This can be?
Primary (Isolated)
or
Secondary
1. Myelomeningocele
2. Filum terminale lipoma
3. Trauma)
Primary and Secondary masses are likely shown on ?
The secondary types are more likely shown on MR (to showcase the associated mass -fluid collection), the primary types are more likely shown on US - as a straight counting game.
Imaging Feature of Low Lying cord/Tethered cord on MRI
Low conus (belowL2), and thickened filum terminale (> 2mm).
Difference between meningomyelocele vs lipomyelomeningocele with their associated conditions?
meningomyelocele is associated with
Chiari malformations,
lipomyelomeningocele is NOT.
What condition has a high risk of Occult Cord problems (including tethering) and should be screened?
Anal atresia
Low lying / tethered cords are closely linked with with what condition?
Spina Bifida (Tufts on Hair)
Patient with Dimples. Whoe should we screen?
High Dimples (Above the gluteal creases) DO NEED screenig
Low dimples (bewlow the gluteal crease) do not deed screening
Thethered Cord - With a Lipoma (Fat Signal Mass) - Super classic
This is a developmental variant.
Normally, a large portion o f the distal cord involutes in a late stage of spinal cord embryology. Sometimes this process is not uniform and you get stuck with a stupid looking cyst at the end of your cord.
Terminal Ventricle (ventriculus terminalis)
This is considered a fatigue or stress fracture, probably developing in childhood. It is a classic cause of back pain in an adolescent athlete.
Pars Interarticularis Defects (Spondylolysis):
The process represents a hole / break in the coimecting bone between the superior and inferior articular facets. If there is forward “slippage” you can deploy the word spondylolisthesis.
90% of Pars interarticularis Defects (Spondylolysis) are seen in what level?
L5 (2nd most common at L4)
“collar on the scottie dog.”
Pars Interarticularis Defects (Spondylolysis)
Pares defects + Anterolishtesis =
Neuroforaminal Stenosis with spinal canal widening.
This is the result of a failure of the closure of the primary neural tube, with obvious exposure of the neural placode through a midline defect of the skin.
Open Spinal Dysraphisms:
Spinal Dysraphism groups
CLOSED - Defect is covered by skin (Spina bifida oculta)
or
OPEN - neural tissue exposed through a defect in bone and skin (Sipna bifida aperta)
What happens to teh cord in Open Spinal Dysraphisms
Cord with be tethered
Open Spinal dyraphisms are associated with what condition?
Diastematomyelia
Chiari II malformatoins
This is the more rare type where the neural placode is flush with the skin.
Myelocele
This is the more common type (98%) where the neural placode protrudes above the skin. These are more common with Chiari II malformations.
Myelomenigocele
What are Closed Spina Dysraphism with Cubcutaneou mass?
Meningocele
Lipomyelocele / Lipomyelomeningocele
Terminal Myelocystocele
This is herniation of a CSF filled sac through a defect in the posterior elements (spina bifida). It is most typical in the lumbar or sacral regions.
Although they can occur in the cervical spine.
Meningocele
Meningocele
These are lipomas with a dural defect (former with the neural placode-lipoma interface inside the canal & latter with it outside the canal).
Lipomyelocele / Lipomyelomeningocele
subcutaneous fatty mass above the gluteal crease
Lipomyelocele / Lipomyelomeningocele
Lipomyelocele / Lipomyelomeningocele are 100% associated with?
Tethered cord
This is a herniation of a terminal
syrinx into a posterior meningocele via a posterior spinal defect.
Terminal Myelocystocele
Terminal Myelocystocele
What are the Closed Spinal Dysraphisms without Subcutaneous Mass?
- Intradural Lipomas
- Fibrolipoma of the filum terminale
- Tight filum terminale
- Dermal Sinus
Intradural lipomas
Most common in the thoracic spine along the dorsal aspect. They don’t need to be (but can be) associated with posterior element defects.
Fibrolipoma of the filum terminale
This is often an incidental finding “fatty filum”. There will be a linear T1 bright structure in the filum terminale. The filum is not going to be unusually thickened and the conus will be normally located.
Thickened filum terminale (>2 mm) + Low lying conus (Below theinferior end plate of L2)
Thickened filum terminale (>2 mm) + Low lying conus (Below theinferior end plate of L2)
This is the result of stretching the cord with growth of the canal.
Tight filum terminale
The “tethered cord syndrome” is based on what?
he clinical findings of low back pain and leg pain plus urinary bladder dysfunction.
This is an epithelial lined tract that extends from the skin to deep soft tissues (sometimes the spinal canal, sometimes a dermoid or lipoma).
Dermal Sinus
Diastematomyelia
This describes a sagittal split in the spinal cord. They almost always occur between T9-S1, with normal cord both above and below the split.
Two thecal sacs and each hemi-cord has its own central canal and dorsal/ventral horns
Diastematomyelia
This is a spectrum o f defects in the caudal region that ranges from partial agenesis of the coccyx to lumbosacral agenesis.
Caudal regression
Caudal Regression is associated with these conditions
VACTERL
Curarino triad
Maternal diabetes + “Blunted sharp” high terminating cord + “ Shield sign” from opposed iliac bones (no sacrum)
Caudal regression
Meningocele of Currarino is anterior or posterior?
Anterior
Currarino Triad
