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Matt's Lists > PEDS Spine > Flashcards

PEDS Spine Flashcards

1
Q

EG in the Spine (vertebral body). Initial Mgmt?

A

Observation. Will reconstitute.

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2
Q

Didn’t work. Now what?

A

Bracing.

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3
Q

Good idea. Now expanding into canal on MR but no neuro signs. Ideas?

A

Steroid Injection.

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4
Q

Perfect. Now neuro signs.

A

Decompression via surgery

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5
Q

Name 2 Multi-focal EG Conditions

A 
Hand-Schuller-Christian = visceral involvement.   Exophtalmos & DI.   AKA Langerhans Cell Histiocytosis
Letterer-Siwe = fatal form in very young.
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6
Q

What causes (not trauma) AARI?

A

Ligamentous & capsular Laxity

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7
Q

If AARI w/ abscess post URTI what is the name?

A

Grisel’s Syndrome.

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8
Q

Who you gonna call?

A

ENT.

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9
Q

Imaging in Grisel’s?

A

MRI > CT.

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10
Q

Treatment options for AARI? (all types) list 4.

A

NSAIDS & Collar.

Traction.

Halo Vest

Fusion

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11
Q

Scheurmann’s Kyphosis. Define it.

A

5 degrees of wedging in 3 consecutive levels.

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12
Q

Scheurmann’s Kyphosis. 1e curve?

A

Thoracic Kyphosis

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13
Q

Scheurmann’s Kyphosis. 2e curves? (2)

A

Cervical & Lumbar Lordosis

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14
Q

DDx for Scheurmann’s Kyphosis. . 3

A 
Postural Kyphosis.
Congenital Kyphosis
Tumour
Compression #
Skeletal Dysplasia
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15
Q

Scheurmann’s Kyphosis. Cobb <60. Rx?

A

PT, Follow q6/12.

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16
Q

Scheurmann’s Kyphosis. Cobb 60-80. Rx?

A

Brace if skeletal immaturity.

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17
Q

Scheurmann’s Kyphosis. Cobb 80+. Rx?

A

Surgery

18
Q

Surgical Plan?

A

Anterior Release.
Pedicle Subtraction Osteotomy at Apex
Segmental Spinal Fixation

19
Q

Torticollis. Define it.

A

Head Tilt to one side.

Head turns to affected side.

Chin turns away from affected side.

SCM contracted.

20
Q

Torticollis. Ortho DDx. 2

A

AARI
Klippel Feil
Congenital

21
Q

Torticollis. Non-Ortho DDx. 2

A

Grisel’s

Tumour

22
Q

Torticollis - Imaging?

A

XR if no ST mass. Rule out AARI or KF.

US if mass.

23
Q

Torticollis - Treatment?

A

PT & Stretching.

90% respond within a yr.

24
Q

Torticollis - Surgical Rx?

A

Indications if 1yr+ or 30 degrees+ contracture. SCM Z plasty/release.

25
Q

Klippel-Feil. Define it.

A

Multiple abnormal C-Spine Segments. 3-8 wks in utero - cervical somite bodies.

26
Q

Klippel Feil Associations.

A 
Webbed Neck.
Low Hair Line.
Big Jaw.
Scoliosis.
Sprengel's
Synkinesis.
Congenital Heart Issue
Brainstem abnormality.
AAI - 50%
Cervical Stenosis
27
Q

Klippel Feil. Rx.

A

Observation, counsel to avoid neck at risk sports. Contact, flipping, gymnastics, etc.

28
Q

Klippel Feil. Surgery Indications

A

Basilar Invagination. Chronic Pain. Myelopathy. AARI. Adjacent level disease.

29
Q

Spondylolysis & Listhesis. Classify - (5)

A 
Congenital (dysplastic)
Isthmic
Traumatic
Neoplastic
Degenerative
30
Q

Define Spondylolysis & Listhesis

A

Anatomic defect (gap) in the pars with adjacent sclerosis.

Translation of one body on the next.

31
Q

What % of kids with lysis progress to listhesis?

A

15.

32
Q

Most common level in kids?

in adults?

A

Kids. L5/S1.

Adults. L4/5

33
Q

What is most likely to progress?

A

Larger Slip (grade) & dysplastic.

34
Q

How do you grade slip?

A 
Myerding.
1 - <25%
2 - 25-50
3 - 50-75
4 - 75-100
5 - Spondyloptosis
35
Q

How to draw SLIP ANGLE?

A 
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.
36
Q

____ + _____ = ______

SS, PI, PT.

A

PI = PT + SS

37
Q

Indications for surgery?

A

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.

38
Q

Define PT

A

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.

39
Q

Define SS

A

Sacral slope is the version of the S1 endplate. To measure, the S1 endplate off a horizontal line from posterior S1.

40
Q

Define PI

A

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.

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