pediatric spine

Question 1

at what 3 sites do spinal growth occur

Answer 1

-Vertical end plates: growth in height
-Articular facets
-Neurocentral synchondrosis
(located in each pedicle) accounts for enlargement of vertebral canal

Question 2

What is the definition of scoliosis

Answer 2

defined as lateral curvature of the spine measuring greater than 10o

Question 3

Does functional or structural scoliosis have vertebral rotation

Answer 3

Structural

Question 4

When placed in NWB (supine) is there a correction for functional scoliosis

Answer 4

yes

Question 5

Funcational scoliosis maybe caused by

Answer 5

*leg length discrepancy
true discrepancy or hip dislocation or rotated innominate
*muscle spasm or pain: from nerve root or other cause
*habitual poor posture: standing or sitting

Question 6

What direction with structural scoliosis does the vertebral bodies rotate toward ?

Answer 6

Convexity with max rotation at the apex of the curve

Question 7

What direction does the spinous process rotate toward for structural scoliosis

Answer 7

Concavity

Question 8

What side is the rib hump on secondary to the roation (structural)

Answer 8

Convexity

Question 9

What direction is the prominence of the ribs on the side of spinal convexity?

Answer 9

Posterior

Question 10

causes of structural scoliosis

Answer 10

A. neuromuscular
B. Osteopathic (failure in forming)
C. idiopathic (most common)

Question 11

Other spinal or organ anomalies associated with congenital spine malformation

Answer 11

Hair patch
Unequal foot size
Asymmetric LE circumference; strength
Urinary tract deficits
Facial asymmetries
Sprengel deformity: partially undescended scapulae
Congenital heart disease

Question 12

What are the structural scoliosis that defined by age of onset

Answer 12

infantile 0-3yo
Juvenile 4-10 yo
adolescent >10yo

Question 13

with infantile at what percent is it more like to progress

Answer 13

Rib Vertebral angle difference (RVAD) > 20%

Question 14

For infantile idiopathic scoliosis what are the interventions

Answer 14

• Curves: <25 degrees with RVAD, 20 observe and monitor at regular intervals
• Curves above those parameters brace; intermittent Risser casting
• Surgery if the forementioned not successful

Question 15

T/f Juvenile has a high rate of progression

Answer 15

True

Question 16

What are the intervention for juvenile s.

Answer 16

Curve < 25 degrees monitor with radiographs
Curves 25-40 bracing; flexible curves may consider bracing even at 40-50
Bracing also for curves less than 25 when the progression to 20-25 range occurred quickly
Surgery inflexible curves exceed 40 degrees and virtually any curve that exceeds 50

Question 17

What are the theories for idiopathic scoliosis

Answer 17

bone malformation during development, asymmetric muscle weakness, abnormal postural control secondary to vestibular dysfunction

Question 18

Definition of curve progression

Answer 18

Defined as an increase of 5 degrees or more on two consecutive examination at 4-6 month intervals

Question 19

What factors influence progression of curve for scoliosis

Answer 19

Younger pt.>progression
Double curve> risk than single curve
The lower the Risser sign the > risk
> magnitude > risk
F 10 times > risk than M
> risk if curve presents before menarche

Question 20

How is the curve defined?

Answer 20

1. Location
   determined by the apex; apex is the vertebrae that is most distant from the midline of the spine
2. Direction
   determined by the convex side of the curve
3. Magnitude
   measured by the Cobb Method

Question 21

The Scoliosis Research Society’s Classification of Curvature by Anatomic area is as follows (location)

Answer 21

Cervical Curve: apex between C1 - C6
Cervicothoracic Curve:  apex at C7- T1
Thoracic Curve:  apex between T2 - T11 
Thoracolumbar Curve:  apex at T12 - L1
Lumbar Curve:  apex between L2 - L4
Lumbosacral Curve:  apex at L5 - S1

Question 22

Transitional vertebra

Answer 22

is the one that marks the end of the curve

Question 23

define the Cobb method (magnitude)

Answer 23

Use lateral and A/P radiographs to locate the pedicles and the spinous process. Normal: symmetrical pedicles, spinous processes are in midline

Measures the lateral bend

Question 24

What are the grades of the Cobb method

Answer 24

Grade 0: no rotation

Grade I: minimal rotation

Grade II: moderate

Grade III: mod-severe rotation

Grade IV: severe rotation

Question 25

Define Risser’s sign (assessment of skeletal maturity)

Answer 25

degree of closure of the iliac apophysis; ossifies lateral to medial

Question 26

What are the stages of risser’s sign

Answer 26

Stages 0-1: occurs early in adolescent growth spurt
Stages 1-4: progression of closure
Stage 5: fused and skeletal maturity

Question 27

How is the severity of the curve defined for scoliosis

Answer 27

Mild: 10 < 20o
Moderate: 20-40o
early structural changes in vertebrae and rib cage
Severe: >40-50o
significant deformity; pain, DJD, cardiopulmonary changes

Question 28

What are the aspects of curve identification

Answer 28

Magnitude, location, direction

Question 29

What is typically weak with scoliosis

Answer 29

Convex stretched and typically weaker

abdominal and trunk extensor are also typically weak

Question 30

what are some exercise interventions for scoliosis

Answer 30

stretch tight muscles; pecs, LE
flexibility exercises: LE, cervical, trunk (lateral flexion exercises, trunk shifts)
strengthen weak muscles: trunk, abdominal, obliques, hip
posture awareness (mirror)
posture in various positions
teach exercises for in and out of brace
respiratory exercises
ball exercises
curve correction

Question 31

At what degree is bracing recommended

Answer 31

> 25o

to 45 degrees