pediatric spine Flashcards
at what 3 sites do spinal growth occur
-Vertical end plates: growth in height
-Articular facets
-Neurocentral synchondrosis
(located in each pedicle) accounts for enlargement of vertebral canal
What is the definition of scoliosis
defined as lateral curvature of the spine measuring greater than 10o
Does functional or structural scoliosis have vertebral rotation
Structural
When placed in NWB (supine) is there a correction for functional scoliosis
yes
Funcational scoliosis maybe caused by
*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
What direction with structural scoliosis does the vertebral bodies rotate toward ?
Convexity with max rotation at the apex of the curve
What direction does the spinous process rotate toward for structural scoliosis
Concavity
What side is the rib hump on secondary to the roation (structural)
Convexity
What direction is the prominence of the ribs on the side of spinal convexity?
Posterior
causes of structural scoliosis
A. neuromuscular
B. Osteopathic (failure in forming)
C. idiopathic (most common)
Other spinal or organ anomalies associated with congenital spine malformation
Hair patch Unequal foot size Asymmetric LE circumference; strength Urinary tract deficits Facial asymmetries Sprengel deformity: partially undescended scapulae Congenital heart disease
What are the structural scoliosis that defined by age of onset
infantile 0-3yo
Juvenile 4-10 yo
adolescent >10yo
with infantile at what percent is it more like to progress
Rib Vertebral angle difference (RVAD) > 20%
For infantile idiopathic scoliosis what are the interventions
- 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
T/f Juvenile has a high rate of progression
True
What are the intervention for juvenile s.
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
What are the theories for idiopathic scoliosis
bone malformation during development, asymmetric muscle weakness, abnormal postural control secondary to vestibular dysfunction
Definition of curve progression
Defined as an increase of 5 degrees or more on two consecutive examination at 4-6 month intervals
What factors influence progression of curve for scoliosis
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
How is the curve defined?
- Location
determined by the apex; apex is the vertebrae that is most distant from the midline of the spine - Direction
determined by the convex side of the curve - Magnitude
measured by the Cobb Method
The Scoliosis Research Society’s Classification of Curvature by Anatomic area is as follows (location)
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
Transitional vertebra
is the one that marks the end of the curve
define the Cobb method (magnitude)
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
What are the grades of the Cobb method
Grade 0: no rotation
Grade I: minimal rotation
Grade II: moderate
Grade III: mod-severe rotation
Grade IV: severe rotation
