PEDIATRIC Section 14: Pediatric Spine Flashcards

1
Q
A
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2
Q

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

This can be?

A

Primary (Isolated)

or

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

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3
Q

Primary and Secondary masses are likely shown on ?

A

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.

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4
Q

Imaging Feature of Low Lying cord/Tethered cord on MRI

A

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

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5
Q

Difference between meningomyelocele vs lipomyelomeningocele with their associated conditions?

A

meningomyelocele is associated with
Chiari malformations,

lipomyelomeningocele is NOT.

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6
Q

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

A

Anal atresia

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7
Q

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

A

Spina Bifida (Tufts on Hair)

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8
Q

Patient with Dimples. Whoe should we screen?

A

High Dimples (Above the gluteal creases) DO NEED screenig

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

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9
Q
A

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

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10
Q

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.

A

Terminal Ventricle (ventriculus terminalis)

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11
Q

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

A

Pars Interarticularis Defects (Spondylolysis):

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12
Q
A

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.

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13
Q

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

A

L5 (2nd most common at L4)

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14
Q

“collar on the scottie dog.”

A

Pars Interarticularis Defects (Spondylolysis)

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15
Q

Pares defects + Anterolishtesis =

A

Neuroforaminal Stenosis with spinal canal widening.

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16
Q

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.

A

Open Spinal Dysraphisms:

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17
Q

Spinal Dysraphism groups

A

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

or

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

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18
Q

What happens to teh cord in Open Spinal Dysraphisms

A

Cord with be tethered

19
Q

Open Spinal dyraphisms are associated with what condition?

A

Diastematomyelia
Chiari II malformatoins

20
Q

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

A

Myelocele

21
Q

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

A

Myelomenigocele

22
Q

What are Closed Spina Dysraphism with Cubcutaneou mass?

A

Meningocele
Lipomyelocele / Lipomyelomeningocele
Terminal Myelocystocele

23
Q

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.

A

Meningocele

24
Q
A

Meningocele

25
Q

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

A

Lipomyelocele / Lipomyelomeningocele

26
Q

subcutaneous fatty mass above the gluteal crease

A

Lipomyelocele / Lipomyelomeningocele

27
Q

Lipomyelocele / Lipomyelomeningocele are 100% associated with?

A

Tethered cord

28
Q

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

A

Terminal Myelocystocele

29
Q
A

Terminal Myelocystocele

30
Q

What are the Closed Spinal Dysraphisms without Subcutaneous Mass?

A
  1. Intradural Lipomas
  2. Fibrolipoma of the filum terminale
  3. Tight filum terminale
  4. Dermal Sinus
31
Q

Intradural lipomas

A

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

32
Q

Fibrolipoma of the filum terminale

A

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.

33
Q

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

A

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

34
Q

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

A

Tight filum terminale

35
Q

The “tethered cord syndrome” is based on what?

A

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

36
Q

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

A

Dermal Sinus

37
Q

Diastematomyelia

A

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.

38
Q

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

A

Diastematomyelia

39
Q

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

A

Caudal regression

40
Q

Caudal Regression is associated with these conditions

A

VACTERL
Curarino triad

41
Q

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

A

Caudal regression

42
Q

Meningocele of Currarino is anterior or posterior?

A

Anterior

43
Q

Currarino Triad

A