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)