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Ortho - Pediatrics > Scoliosis > Flashcards

Scoliosis Flashcards

1
Q

Definition of idiopathic adolescent scoliosis

A

Idiopathic scoliosis in kids 10-18 years old

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2
Q

Most common curve seen in idiopathic adolescent scoliosis?

A

Right thoracic. Left thoracic curves are rare and require MRI to rule out cyst or syrinx

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3
Q

Curvature associated with cardiopulmonary dysfunction and early death?

A

90 degrees

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4
Q

Risk factors for curve progression

A

> 25 degrees before skeletal maturity
50 thoracic or > 40 lumbar curve after skeletal maturity progresses at 1-2 degrees per year
lumbar
Double > single

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5
Q

Best predictor of curve progression

A

Peak growth velocity, if curve is > 30 degrees before this time they need surgery

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6
Q

When do girls typically reach skeletal maturity?

A

1.5 years after puberty

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7
Q

Classification systems

A

King-Moe and Lenke

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8
Q

Tool used in school screening exams

A

7 degree threshold on scoliometer

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9
Q

Physical exam

A

Adams forward bending, have patient sit if concerned limb length is causing curve.
Leg length, skin defects, shoulder height, truncal shift, rib prominence, pelvic tilt, cafe-au-lait spots, pes cavovarus, Hoffman, Babinski, clonus, sacral dimple/hair,

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10
Q

Radiographs

A

Cobb angle > 10 degrees in positive
Stable zone: vertical lines from lumbosacral facets
Stable vertebrae: most proximal vertebrae aligned centrally with central sacral vertical line
Neural vertebrae: spinous processes equidistant from pedicles on PA (not rotated)
Apical vertebrae: vertebra farther from center

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11
Q

Determining spine balance on plain radiographs in the coronal and sagittal planes

A

Coronal: C7 plumb to central sacral vertical line
Sagittal: C7 plumb to posterior and superior corner of S1

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12
Q

Indications for MRI

A 
Atypical curve (left thoracic, short angular and atypical/excessive kyphosis)
Rapid progression
Neurologic symptoms
Foot deformity
Abnormal abdominal reflexes (T5-T12)
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13
Q

Indications for observation alone

A

Cobb angle

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14
Q

Indications for bracing (stops progression, doesn’t reverse)

A 
Cobb angle 25-45
Skeletally immature (Risser 0, 1, 2)
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15
Q

Patients with poor prognosis w/bracing

A

Poor correction w/brace
Hypokyphosis
Obese, male, non-compliant

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16
Q

Indications for posterior spinal fusion

A

Cobb angle > 45

Gold standard for thoracic & double major curves

17
Q

Indications for anterior spinal fusion

A

Thoracolumbar and lumbar deformity with normal sagittal profile

18
Q

Indications for anterior-posterior fusion

A

Curves > 75 degrees
Stiff curves
Risser grade 0, boys

19
Q

Minimum requirement to wear brace to slow scoliosis progression

A

12 hrs/day

20
Q

Definition of bracing failure

A

> 6 degrees or more of progression

Progression to > 45 degrees

21
Q

Definition of skeletal maturity

A

Risser 4

22
Q

If possible, always avoid fusion of what levels in posterior fusions for scoliosis?

A

L4-L5, increased incidence of back pain with L5 fusions

23
Q

How to avoid crankshaft phenomenon

A

Perform anterior discectomy and fusion in patients that are very young and are undergoing posterior spinal fusion

24
Q

Scoliosis surgery complications

A

Nerve injury, crankshaft phenomenon, SMA syndrome, infection, flat back syndrome and hardware failure.

25
Q

Definition of juvenile idiopathic scoliosis

A

Onset between ages 4-10

26
Q

Conditions associated with juvenile idiopathic scoliosis

A 
Syringomyelia
Arnold-Chiari malformation
Tethered cord
Dysraphisms
Spinal cord tumors
Bowel/bladder dysgenesis
27
Q

Infantile idiopathic scoliosis

A

Scoliosis in children less than 3

28
Q

Infantile idiopathic scoliosis unusual epidemiological factors

A

Boys > girls, left curve > right curve, most resolve spontaneously

29
Q

What spinal segment grows most rapidly in the 1st 5 years of life?

A

T1-L5

30
Q

Rib vertebral angle difference (RVAD)

A

Measure between endplate and rib (line between midpoint of rib head and neck). Then take the difference from another angle. > 20 degrees = high rate of progression.

31
Q

How does neuromuscular scoliosis differ from idiopathic?

A

Progresses more rapidly, even after maturity
Associated with pelvic obliquity
Involve more vertebra
High rate of pulmonary complications with surgery

32
Q

Neuromuscular diseases associated with scoliosis

A

CP, Rett syndrome, SMA, muscular dystrophy, spina bifida and polio

33
Q

Schuermann’s kyphosis

A

Rigid thoracic hyperkyphosis > 45 degrees due to anterior wedging > 5 degrees across 3 or more vertebra

34
Q

Schmorl’s node

A

Disc herniation into vertebral body. Seen in Schuermann’s kyphosis.

Ortho - Pediatrics (1 decks)

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