PEDIATRIC Section 14: Pediatric Spine

Question 1

Answer 1

Question 2

Because the canal grows faster than the cord, a fixed attachment (“tethering”) results in cord stretching and subsequent ischemia.

This can be?

Answer 2

Primary (Isolated)

or

Secondary
1. Myelomeningocele
2. Filum terminale lipoma
3. Trauma)

Question 3

Primary and Secondary masses are likely shown on ?

Answer 3

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.

Question 4

Imaging Feature of Low Lying cord/Tethered cord on MRI

Answer 4

Low conus (belowL2), and thickened filum terminale (> 2mm).

Question 5

Difference between meningomyelocele vs lipomyelomeningocele with their associated conditions?

Answer 5

meningomyelocele is associated with
Chiari malformations,

lipomyelomeningocele is NOT.

Question 6

What condition has a high risk of Occult Cord problems (including tethering) and should be screened?

Answer 6

Anal atresia

Question 7

Low lying / tethered cords are closely linked with with what condition?

Answer 7

Spina Bifida (Tufts on Hair)

Question 8

Patient with Dimples. Whoe should we screen?

Answer 8

High Dimples (Above the gluteal creases) DO NEED screenig

Low dimples (bewlow the gluteal crease) do not deed screening

Question 9

Answer 9

Thethered Cord - With a Lipoma (Fat Signal Mass) - Super classic

Question 10

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.

Answer 10

Terminal Ventricle (ventriculus terminalis)

Question 11

This is considered a fatigue or stress fracture, probably developing in childhood. It is a classic cause of back pain in an adolescent athlete.

Answer 11

Pars Interarticularis Defects (Spondylolysis):

Question 12

Answer 12

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.

Question 13

90% of Pars interarticularis Defects (Spondylolysis) are seen in what level?

Answer 13

L5 (2nd most common at L4)

Question 14

“collar on the scottie dog.”

Answer 14

Pars Interarticularis Defects (Spondylolysis)

Question 15

Pares defects + Anterolishtesis =

Answer 15

Neuroforaminal Stenosis with spinal canal widening.

Question 16

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.

Answer 16

Open Spinal Dysraphisms:

Question 17

Spinal Dysraphism groups

Answer 17

CLOSED - Defect is covered by skin (Spina bifida oculta)

or

OPEN - neural tissue exposed through a defect in bone and skin (Sipna bifida aperta)

Question 18

What happens to teh cord in Open Spinal Dysraphisms

Answer 18

Cord with be tethered

Question 19

Open Spinal dyraphisms are associated with what condition?

Answer 19

Diastematomyelia
Chiari II malformatoins

Question 20

This is the more rare type where the neural placode is flush with the skin.

Answer 20

Myelocele

Question 21

This is the more common type (98%) where the neural placode protrudes above the skin. These are more common with Chiari II malformations.

Answer 21

Myelomenigocele

Question 22

What are Closed Spina Dysraphism with Cubcutaneou mass?

Answer 22

Meningocele
Lipomyelocele / Lipomyelomeningocele
Terminal Myelocystocele

Question 23

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.

Answer 23

Meningocele

Question 24

Answer 24

Meningocele

Question 25

These are lipomas with a dural defect (former with the neural placode-lipoma interface inside the canal & latter with it outside the canal).

Answer 25

Lipomyelocele / Lipomyelomeningocele

Question 26

subcutaneous fatty mass above the gluteal crease

Answer 26

Lipomyelocele / Lipomyelomeningocele

Question 27

Lipomyelocele / Lipomyelomeningocele are 100% associated with?

Answer 27

Tethered cord

Question 28

This is a herniation of a terminal syrinx into a posterior meningocele via a posterior spinal defect.

Answer 28

Terminal Myelocystocele

Question 29

Answer 29

Terminal Myelocystocele

Question 30

What are the Closed Spinal Dysraphisms without Subcutaneous Mass?

Answer 30

1. Intradural Lipomas 2. Fibrolipoma of the filum terminale 3. Tight filum terminale 4. Dermal Sinus

Question 31

Intradural lipomas

Answer 31

Most common in the thoracic spine along the dorsal aspect. They don’t need to be (but can be) associated with posterior element defects.

Question 32

Fibrolipoma of the filum terminale

Answer 32

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.

Question 33

Thickened filum terminale (>2 mm) + Low lying conus (Below theinferior end plate of L2)

Answer 33

Thickened filum terminale (>2 mm) + Low lying conus (Below theinferior end plate of L2)

Question 34

This is the result of stretching the cord with growth of the canal.

Answer 34

Tight filum terminale

Question 35

The “tethered cord syndrome” is based on what?

Answer 35

he clinical findings of low back pain and leg pain plus urinary bladder dysfunction.

Question 36

This is an epithelial lined tract that extends from the skin to deep soft tissues (sometimes the spinal canal, sometimes a dermoid or lipoma).

Answer 36

Dermal Sinus

Question 37

Diastematomyelia

Answer 37

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.

Question 38

Two thecal sacs and each hemi-cord has its own central canal and dorsal/ventral horns

Answer 38

Diastematomyelia

Question 39

This is a spectrum o f defects in the caudal region that ranges from partial agenesis of the coccyx to lumbosacral agenesis.

Answer 39

Caudal regression

Question 40

Caudal Regression is associated with these conditions

Answer 40

VACTERL Curarino triad

Question 41

Maternal diabetes + "Blunted sharp" high terminating cord + " Shield sign" from opposed iliac bones (no sacrum)

Answer 41

Caudal regression

Question 42

Meningocele of Currarino is anterior or posterior?

Answer 42

Anterior

Question 43

Currarino Triad

Answer 43