Spinal Pathology Flashcards
1
Q
Each vertebra will develop how many different ossification centres?
A
3
2
Q
The centrum forms what?
A
The central portion of the vertebral body
3
Q
The two neural processes of the vertebra will form what? 5
A
- Pericles
- Transverse processes
- Laminar
- Spinous process
- Posterolateral part of the vertebral body
4
Q
In terms of the 3 ossification centres, how visible is each ossification centers?
A
Only parts of the fetal spine are visible
5
Q
Ossification is not complete in the laminae until when?
A
18 weeks
6
Q
Potentially a small spina bifida could be missed when?
A
Prior to 18 weeks
7
Q
What are the chances of getting NTD?
A
1/1000 births
8
Q
What increases risk of NTD? 4
A
- Valproic acid
- Maternal diabetes
- Folic acid deficiency
- History of spinal defects
9
Q
What is valproic acid used for?
A
Medication for seizure
10
Q
What history of spinal defects are important? 2
A
- Previous pregnancy
- Family history of NTD
11
Q
What is spina bifida? 3
A
Defect in structure of the spinal canal that ma result in the herniation of its contents.
1. Meninges
2. CSF
3. Neural tissue
12
Q
What kind of defect is spina bifida?
A
NTD
13
Q
Besides spinal bifida what are other examples of NTD? 2
A
- Encephalocele
- Anencephaly
14
Q
What is Encephalocele?
A
Brain herniating through defect in cranium
15
Q
What is anencephaly?
A
Missing cranium and brain
16
Q
What are two types of spina bifida?
A
- Occulta
- Aperta
17
Q
What does spina bifida involve?
A
Only the deeper layer
18
Q
What may we see with spina bifida?
A
May only see a skin dimple or patch of hair on the skin
19
Q
What is spina bifida occulta look like?
A
Closed defect
20
Q
How many cases of spinal bifida are occulta?
A
15-20% of cases
21
Q
What does Occult mean?
A
Hidden or concealed
22
Q
What is spina bifida aperta? What does it involve?
A
- Open defect
- Involves all layers from dura to skin
23
Q
How many cases are aperta cases in terms of spina bifida?
A
80-85%
24
Q
What are two types of spina bifida aperta?
A
- Meningococcal
- Myelomeningocele
25
What is spina bifida aperta Meningocele?
Spina bifida aperta which contains meninges and CSF
26
What is spina bifida aperta Myelomeningocele?
Contains meninges, CSF and neural tissue
27
What does Spinal NTD look like on U/S? 2
1. Splayed laminae
2. Protruding mass or cyst
28
When looking for spinal NTD what should we look for association with? What are the signs?
Arnold Chiari II malformation, ventriculomegaly. These signs are
1. Obliterated cisterna magna
2. Banana sign with cerebellum
3. Lemon sign
29
When is screening for MS AFP done?
Quad screen which is at 16 weeks
30
AFP is produced where in the fetus?
Fetal liver
31
Can AFP cross the placenta?
Yes
32
Gestational age must be considered as AFP level. Why?
The MS AFP level varies with gestational age
33
MS AFP is elevated with NTD that are what?
NTD that are not covered by skin (Aperta)
34
What are causes of elevated MS AFP? 6
1. Abdominal wall defects
2. Multiple fetal pregnancy
3. Fetal death
4. Urinary obstruction
5. Cystic hygroma
6. Incorrect dates
35
What are some abdominal wall defects associated with MS AFP? 2
1. Omphalocele
2. Gastroschisis
36
What are the most common location of NTD?
Lumbosacral spine
37
What chromosomal anomalies is NTD associated with? 3
1. T18
2. Triploidy
3. Meckel Gruber syndrome
38
What is spinal dysgraphia?
Abnormal closure of the spine
39
What is another name for Rachischisis? Explain the breakdown of the name? 4
Another name for spinal dysraphism
1. Rachis meaning spine
2. Schisms meaning division
3. Failure of the fusion of the vertebral arches
40
Label the image
41
What does this image demonstrate?
A meningocele
42
What are some landmarks of NTD?3
1. T12 most distal rib
2. L5 superior margin of iliac wing
3. S4 Most caudal ossification center in 2nd trimester
43
What does this image represent?
The different NTD landmarks
44
How does NTD lead to in terms of legs?2
1. Clubfoot (seen on U/S)
2. Hip dislocation (not seen on U/S)
45
Why are there leg disorders from NTD?
1. Caused by an imbalance of muscular activity due to nerve involvement (impairment) caused by the neural tube defect
2. Nerves exposed to amniotic fluid results in damage to these nerves
46
What does this image demonstrate?
Arnold Chiari II malformation
47
What does this image represent?
Lemon and Banana Sign
48
What does this image demonstrate?
Spinal Dysraphism
49
What does each of these images represent?
Transverse spinal Dysraphism
50
What does this image represent?
Meningocele
51
Assessment of the spine is best done in which plane?
Transverse
52
What does this image represent?
A transverse, Sagittal, and coronal view of a meningocele
53
What is the prognosis of a meningocele/NTD? What happens the more superior the NTD?
1. Depends on location and extent of neural tissue involved
2. The more superior in the spine the greater the disability
54
What is iniencephaly?
Special case of dysprahism involving the back of the cranium and c-spine
55
The inien refers to what in iniencephaly?
The nape of the neck
56
With Iniencephaly, segmentation errors of the upper spine does what?
Shortens the neck and the head becomes dorsiflexed
57
What is iniencephaly also known as?
Star gazing position
58
What is Iniencephaly associated with?
Anencephaly
59
What is scoliosis?
Lateral curvature of the spine
60
What is kyphosis?
Exaggerated curvature of the spine in the sagittal plane
61
Both Scoliosis and kyphosis are associated with what conditions? 4
1. Amniotic bad syndrome
2. Skeletal dysplasia
3. VACTERL
4. Caudal regression syndrome
62
What does this image demonstrate?
How Hemivertebra results in scoliosis
63
What is VACTERL sequence?
1. Vertebral (dysraphism)
2. Anal Atresia
3. Cardiovascular
4. Tracheo- Esophageal
5. Renal Anomalies
6. Limb anomalies (radial Ray)
64
What does this image represent?
VACTERL sequence
65
VACTERL sequence is often associated with what conditions? 4
1. Caudal regression
2. Spina Bifida
3. Congenital scoliosis
4. Hemi vertebrae
66
What is the prognosis for VACTERL sequence?
Depends on severity and extent of involvement
67
What is caudal regression?
Range of anomalies of the spine such as absence of part of the spine up to absence of lumbar spine
68
There is an increased risk of caudal regression with what maternal condition?
Type 1 maternal diabetes or IDDM
69
What is sirenomelia? What are S/S? 5
Mermain syndrome
1. Absence of sacrum
2. Fusion of legs
3. Rectal Atresia
4. Renal dysgenesis or agensis
5. Olioghydraminos
70
What is the prognosis of sirenomelia?
All die in infancy
71
What is the most severe form of caudal regression
Sirenomelia
72
What does this image represent?
SIrenomelia
73
What is sacrococcygeal Teratoma? What elements does it contain?
1. Mass adjacent to distal spine
2. Contains elements of many tissues
74
How common are sacrococcygeal Teratomas?
1/35,000 births
75
Teratomas can arise from what? 3
1. Sacrum or coccys
2. Brain
3. Gonads
76
What are 4 types of sacrococcygeal teratomas?
By location
1. External mass predominant 47%
2. External mass with internal components 34%
3. Internal mass predominant with smaller external component 5%
4. Presacral mass (internal only) 10%
77
What is this an image of?
Sacrococcygeal Teratomas
78
How does sacrococcygeal teratomas look like on ultrasound? 2
1. Mass in rump or buttocks area adjacent to spine
2. Displaces the pelvic structures and may compress the ureters causing hydronephrosis
79
If there is AV shunting with Sacrococcygeal teratomas, what happens?
We may see signs of heart failure
80
What does this image represent?
Sacral teratoma
81
What is the prognosis for sacral teratomas? Solid masses have what kind of tendency? What size constitutes a c-section?
1. Depends on size of mass and severity of structure displacement
2. Solid mas has a malignant tendency
3. If >4.5cm cesarean section is indicated
82
What is the DDX for sacral teratomas? 3
1. Rectal duplication
2. Anterior myelomeningocele
3. Sacroma
