Peds Spine

Question 1

Define Klippel Feil

Answer 1

failure of segmentation of cervical vertebrae

- congenital fusion of 2 or more cervical vertebrae

Question 2

Conditions associated with Klippel-Feil

Answer 2

• Sprengel’s
• Renal aplasia
• Deafness
• Atlantoaxial instability
• Congenital cervical stenosis
• Adjacent segment disease

Question 3

Importance of location of Klippel-Feil fusions?

Answer 3

C3 or above are more likely to be symptomatic and require abstaining from contact athletics

Question 4

Classic Klippel Feil triad

Answer 4

low hairline
webbed neck
limited cervical ROM

Question 5

Normal position of the Dens in relation to the McRae line

Answer 5

5mm below it (line between basion and opisthion)

- if above McRae’s line, this is basilar invagination, seen in Klippel Feil

Question 6

what Klippel Feil kids are ok to play football?

Answer 6

fusions 1-2 levels below C3

Question 7

Indications for AIS bracing?

Answer 7

Cuves 20-45 degrees

Risser stage 0, 1, 2

Question 8

define anatomic trajectory of a pedicle screw

Answer 8

22 degrees in a craniocaudal direction

- lower insertional torque if anatomic compared to straight forward

Question 9

what rate of children with a neuraxial abnormality present with an atypical scoliosis curve?

Answer 9

50%

• left thoracic
• double thoracic
• triple
• long right thoracic

Question 10

how many hours a day should a spinal brace be worn for AIS?

Answer 10

> 12 hours
curve progression halted in a dose dependent manner
12 hours use prevented progression in 82% of patients

Question 11

which risser sign is correlated with the greatest velocity of linear growth?

Answer 11

Risser 0 (at age 1 year and at age of puberty)

Question 12

Define Skeletal Maturity

Answer 12

Risser 4
<1cm growth in 2 visits over 6 months apart
2 years post menarchal

can consider stopping bracing at skeletal maturity