Pediatric Spine Flashcards
What age group does juvenile idopathic scoliosis occur?
3-10yo
MC if females; Right thoracic curve more common
70% require treatment
Look for Syrinx, Arnold-Chiari malformation
MRI indicated in kids 20°
What is congenital scoliosis?
failure of normal vertebral development during 4th to 6th week of gestation
caused by developmental defect in the formation of the mesenchymal anlage
What syndrome is a/w congenital scoliosis?
VACTERL V- vertebral malformations A- anal atresia C- cardiac malformations T- tracheoesophageal fistulas R- renal and radial abnormalities L- limb defects
Which type of congenital scoliosis has the biggest potential for progression?
unilateral unsegmented bar with contralateral hemivertebra; treated with excision of hemivertebrae and anerior/posterior fusion
What is the most common type of scoliosis?
Adolescent idiopathic; affects children >10 yo
Right thoracic curve most common; if Left get an MRI
MC in females 10:1
Curves > 90° associated with cardiopulmonary dysfunction, early death, pain, and decreased self image
What adolescent idiopathic scoliosis curves progress before and after maturity?
> 25° before maturity progress
thoracic >50° after maturity progress 1-2°/yr
Lumbar >40° after maturity progress 1-2°/yr
What is the greatest predictor of curve progression with adolescent idiopathic scoliosis?
Peak growth velocity
- if curve is >30° before peak height velocity there is a strong likelihood of the need for surgery
- in females it occurs just before menarche and before Risser 1 (girls usually reach skeletal maturity 1.5 yrs after menarche)
What are other important clinical exam findings with adolescent idiopathic scoliosis?
leg length inequality midline skin defects (hairy patches, dimples, nevi) signs of spinal dysraphism shoulder height differences truncal shift rib rotational deformity (rib prominence) waist asymmetry and pelvic tilt cafe-au-lait spots (neurofibromatosis) foot deformities (cavovarus) can suggest neural axis abnormalities and warrant a MRI asymmetric abdominal reflexes perform MRI to rule out syringomyelia
How are coronal and sagittal balance defined?
- Coronal balance is determined by alignment of C7 plumb line to central sacral vertical line
- Sagittal balance is based on C7 plumb from center of C7 to the posterior-superior corner of S1
In a patient with adolescent idiopathic scoliosis what is an indication to obtain MRI?
1) Left thoracic curve
2) asymmetric abdominal reflexes
3) rapid progression
4) foot deformities
What is the Risser classification?
Risser 0: covers the first 2/3rd of the pubertal growth spurt and correlates with the greatest velocity of skeletal linear growth (Girls 11-13, Boys 13-15); no ilium calcification
Risser I: is given when the ilium calcification measures 25%. As this stage the velocity of linear skeletal growth is on a descending slope.
Risser II: the greater trochanteric apophysis unites with the femur and Ilium calcification measures 50%. There is usually 3 cm of sitting growth remaining and no further growth in the lower extremities.
Risser III: Ilium calcification measures 75%. There is usually 2 cm of sitting growth remaining.
Risser IV: Ilium calcification is almost complete. There is usually 1 cm of sitting growth remaining.
Risser V marks complete skeletal maturation.
What are some basics of posterior spinal fusion for adolescent idiopathic scoliosis?
1) Goal is to correct sagittal and coronal balance while preserving motion
2) Try to avoid fusing to L4 or L5 to decrease back pain
3) Almost never fused to pelvis
At what angle is surgical treatment indicated in adolescent idiopathic scoliosis?
Cobb >45°
When is non-operative treatment appropriate for adolescent idiopathic scoliosis?
1) Cobb angle 25° but
What are some bracing basics for adolescent idiopathic scoliosis?
1) If apex above T7 use Milwaukee brace (cervicothoracolubosacral orthosis)
2) If apex below T7 use TLSO
3) brace for 16-23hrs/day
4) Success is
