PEDS Spine Flashcards
EG in the Spine (vertebral body). Initial Mgmt?
Observation. Will reconstitute.
Didn’t work. Now what?
Bracing.
Good idea. Now expanding into canal on MR but no neuro signs. Ideas?
Steroid Injection.
Perfect. Now neuro signs.
Decompression via surgery
Name 2 Multi-focal EG Conditions
Hand-Schuller-Christian = visceral involvement. Exophtalmos & DI. AKA Langerhans Cell Histiocytosis Letterer-Siwe = fatal form in very young.
What causes (not trauma) AARI?
Ligamentous & capsular Laxity
If AARI w/ abscess post URTI what is the name?
Grisel’s Syndrome.
Who you gonna call?
ENT.
Imaging in Grisel’s?
MRI > CT.
Treatment options for AARI? (all types) list 4.
NSAIDS & Collar.
Traction.
Halo Vest
Fusion
Scheurmann’s Kyphosis. Define it.
5 degrees of wedging in 3 consecutive levels.
Scheurmann’s Kyphosis. 1e curve?
Thoracic Kyphosis
Scheurmann’s Kyphosis. 2e curves? (2)
Cervical & Lumbar Lordosis
DDx for Scheurmann’s Kyphosis. . 3
Postural Kyphosis. Congenital Kyphosis Tumour Compression # Skeletal Dysplasia
Scheurmann’s Kyphosis. Cobb <60. Rx?
PT, Follow q6/12.
Scheurmann’s Kyphosis. Cobb 60-80. Rx?
Brace if skeletal immaturity.
Scheurmann’s Kyphosis. Cobb 80+. Rx?
Surgery
Surgical Plan?
Anterior Release.
Pedicle Subtraction Osteotomy at Apex
Segmental Spinal Fixation
Torticollis. Define it.
Head Tilt to one side.
Head turns to affected side.
Chin turns away from affected side.
SCM contracted.
Torticollis. Ortho DDx. 2
AARI
Klippel Feil
Congenital
Torticollis. Non-Ortho DDx. 2
Grisel’s
Tumour
Torticollis - Imaging?
XR if no ST mass. Rule out AARI or KF.
US if mass.
Torticollis - Treatment?
PT & Stretching.
90% respond within a yr.
Torticollis - Surgical Rx?
Indications if 1yr+ or 30 degrees+ contracture. SCM Z plasty/release.
Klippel-Feil. Define it.
Multiple abnormal C-Spine Segments. 3-8 wks in utero - cervical somite bodies.
Klippel Feil Associations.
Webbed Neck. Low Hair Line. Big Jaw. Scoliosis. Sprengel's Synkinesis. Congenital Heart Issue Brainstem abnormality. AAI - 50% Cervical Stenosis
Klippel Feil. Rx.
Observation, counsel to avoid neck at risk sports. Contact, flipping, gymnastics, etc.
Klippel Feil. Surgery Indications
Basilar Invagination. Chronic Pain. Myelopathy. AARI. Adjacent level disease.
Spondylolysis & Listhesis. Classify - (5)
Congenital (dysplastic) Isthmic Traumatic Neoplastic Degenerative
Define Spondylolysis & Listhesis
Anatomic defect (gap) in the pars with adjacent sclerosis.
Translation of one body on the next.
What % of kids with lysis progress to listhesis?
15.
Most common level in kids?
in adults?
Kids. L5/S1.
Adults. L4/5
What is most likely to progress?
Larger Slip (grade) & dysplastic.
How do you grade slip?
Myerding. 1 - <25% 2 - 25-50 3 - 50-75 4 - 75-100 5 - Spondyloptosis
How to draw SLIP ANGLE?
Lateral view. 1st line up posterior sacrum. 2nd line at 90 to 1st line across S1. 3rd line parallel across L5 inferior endplate. angle between 2 & 3 is SLIP ANGLE.
____ + _____ = ______
SS, PI, PT.
PI = PT + SS
Indications for surgery?
Anyone Failed non-op or slip progressing.
Activity break. TLSO 3mos.
All Grade 3 or higher.
Lysis - dysplastic.
Low grade listhesis:
prorgressive.
neuro deficits
dysplastic
Very controversial for reduction.
Define PT
Pelvic Tilt is the orientation of the sacrum relative to the femoral head. To Draw the angle, it is the angle between a vertical line from the centre of the femoral head and a second line from the femoral head to the middle of S1.
Define SS
Sacral slope is the version of the S1 endplate. To measure, the S1 endplate off a horizontal line from posterior S1.
Define PI
Pelvic Incidence is the combination of SS + PT. It can be measure by combining the two. It can be drawn as a line from the centre of the femoral head to the middle of S1 and measuring the 90 degree tangent from that.
