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DMST 315 OBGYN 3 > Spinal Pathology > Flashcards

Spinal Pathology Flashcards

1
Q

Each vertebra will develop how many different ossification centres?

A

3

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2
Q

The centrum forms what?

A

The central portion of the vertebral body

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3
Q

The two neural processes of the vertebra will form what? 5

A
  1. Pericles
  2. Transverse processes
  3. Laminar
  4. Spinous process
  5. Posterolateral part of the vertebral body
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4
Q

In terms of the 3 ossification centres, how visible is each ossification centers?

A

Only parts of the fetal spine are visible

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5
Q

Ossification is not complete in the laminae until when?

A

18 weeks

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6
Q

Potentially a small spina bifida could be missed when?

A

Prior to 18 weeks

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7
Q

What are the chances of getting NTD?

A

1/1000 births

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8
Q

What increases risk of NTD? 4

A
  1. Valproic acid
  2. Maternal diabetes
  3. Folic acid deficiency
  4. History of spinal defects
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9
Q

What is valproic acid used for?

A

Medication for seizure

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10
Q

What history of spinal defects are important? 2

A
  1. Previous pregnancy
  2. Family history of NTD
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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

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12
Q

What kind of defect is spina bifida?

A

NTD

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13
Q

Besides spinal bifida what are other examples of NTD? 2

A
  1. Encephalocele
  2. Anencephaly
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14
Q

What is Encephalocele?

A

Brain herniating through defect in cranium

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15
Q

What is anencephaly?

A

Missing cranium and brain

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16
Q

What are two types of spina bifida?

A
  1. Occulta
  2. Aperta
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17
Q

What does spina bifida involve?

A

Only the deeper layer

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18
Q

What may we see with spina bifida?

A

May only see a skin dimple or patch of hair on the skin

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19
Q

What is spina bifida occulta look like?

A

Closed defect

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20
Q

How many cases of spinal bifida are occulta?

A

15-20% of cases

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21
Q

What does Occult mean?

A

Hidden or concealed

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22
Q

What is spina bifida aperta? What does it involve?

A
  1. Open defect
  2. Involves all layers from dura to skin
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23
Q

How many cases are aperta cases in terms of spina bifida?

A

80-85%

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24
Q

What are two types of spina bifida aperta?

A
  1. Meningococcal
  2. Myelomeningocele
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25
Q

What is spina bifida aperta Meningocele?

A

Spina bifida aperta which contains meninges and CSF

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26
Q

What is spina bifida aperta Myelomeningocele?

A

Contains meninges, CSF and neural tissue

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27
Q

What does Spinal NTD look like on U/S? 2

A
  1. Splayed laminae
  2. Protruding mass or cyst
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28
Q

When looking for spinal NTD what should we look for association with? What are the signs?

A

Arnold Chiari II malformation, ventriculomegaly. These signs are
1. Obliterated cisterna magna
2. Banana sign with cerebellum
3. Lemon sign

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29
Q

When is screening for MS AFP done?

A

Quad screen which is at 16 weeks

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30
Q

AFP is produced where in the fetus?

A

Fetal liver

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31
Q

Can AFP cross the placenta?

A

Yes

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32
Q

Gestational age must be considered as AFP level. Why?

A

The MS AFP level varies with gestational age

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33
Q

MS AFP is elevated with NTD that are what?

A

NTD that are not covered by skin (Aperta)

34
Q

What are causes of elevated MS AFP? 6

A
  1. Abdominal wall defects
  2. Multiple fetal pregnancy
  3. Fetal death
  4. Urinary obstruction
  5. Cystic hygroma
  6. Incorrect dates
35
Q

What are some abdominal wall defects associated with MS AFP? 2

A
  1. Omphalocele
  2. Gastroschisis
36
Q

What are the most common location of NTD?

A

Lumbosacral spine

37
Q

What chromosomal anomalies is NTD associated with? 3

A
  1. T18
  2. Triploidy
  3. Meckel Gruber syndrome
38
Q

What is spinal dysgraphia?

A

Abnormal closure of the spine

39
Q

What is another name for Rachischisis? Explain the breakdown of the name? 4

A

Another name for spinal dysraphism
1. Rachis meaning spine
2. Schisms meaning division
3. Failure of the fusion of the vertebral arches

40
Q

Label the image

41
Q

What does this image demonstrate?

A

A meningocele

42
Q

What are some landmarks of NTD?3

A
  1. T12 most distal rib
  2. L5 superior margin of iliac wing
  3. S4 Most caudal ossification center in 2nd trimester
43
Q

What does this image represent?

A

The different NTD landmarks

44
Q

How does NTD lead to in terms of legs?2

A
  1. Clubfoot (seen on U/S)
  2. Hip dislocation (not seen on U/S)
45
Q

Why are there leg disorders from NTD?

A
  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
Q

What does this image demonstrate?

A

Arnold Chiari II malformation

47
Q

What does this image represent?

A

Lemon and Banana Sign

48
Q

What does this image demonstrate?

A

Spinal Dysraphism

49
Q

What does each of these images represent?

A

Transverse spinal Dysraphism

50
Q

What does this image represent?

A

Meningocele

51
Q

Assessment of the spine is best done in which plane?

A

Transverse

52
Q

What does this image represent?

A

A transverse, Sagittal, and coronal view of a meningocele

53
Q

What is the prognosis of a meningocele/NTD? What happens the more superior the NTD?

A
  1. Depends on location and extent of neural tissue involved
  2. The more superior in the spine the greater the disability
54
Q

What is iniencephaly?

A

Special case of dysprahism involving the back of the cranium and c-spine

55
Q

The inien refers to what in iniencephaly?

A

The nape of the neck

56
Q

With Iniencephaly, segmentation errors of the upper spine does what?

A

Shortens the neck and the head becomes dorsiflexed

57
Q

What is iniencephaly also known as?

A

Star gazing position

58
Q

What is Iniencephaly associated with?

A

Anencephaly

59
Q

What is scoliosis?

A

Lateral curvature of the spine

60
Q

What is kyphosis?

A

Exaggerated curvature of the spine in the sagittal plane

61
Q

Both Scoliosis and kyphosis are associated with what conditions? 4

A
  1. Amniotic bad syndrome
  2. Skeletal dysplasia
  3. VACTERL
  4. Caudal regression syndrome
62
Q

What does this image demonstrate?

A

How Hemivertebra results in scoliosis

63
Q

What is VACTERL sequence?

A
  1. Vertebral (dysraphism)
  2. Anal Atresia
  3. Cardiovascular
  4. Tracheo- Esophageal
  5. Renal Anomalies
  6. Limb anomalies (radial Ray)
64
Q

What does this image represent?

A

VACTERL sequence

65
Q

VACTERL sequence is often associated with what conditions? 4

A
  1. Caudal regression
  2. Spina Bifida
  3. Congenital scoliosis
  4. Hemi vertebrae
66
Q

What is the prognosis for VACTERL sequence?

A

Depends on severity and extent of involvement

67
Q

What is caudal regression?

A

Range of anomalies of the spine such as absence of part of the spine up to absence of lumbar spine

68
Q

There is an increased risk of caudal regression with what maternal condition?

A

Type 1 maternal diabetes or IDDM

69
Q

What is sirenomelia? What are S/S? 5

A

Mermain syndrome
1. Absence of sacrum
2. Fusion of legs
3. Rectal Atresia
4. Renal dysgenesis or agensis
5. Olioghydraminos

70
Q

What is the prognosis of sirenomelia?

A

All die in infancy

71
Q

What is the most severe form of caudal regression

A

Sirenomelia

72
Q

What does this image represent?

A

SIrenomelia

73
Q

What is sacrococcygeal Teratoma? What elements does it contain?

A
  1. Mass adjacent to distal spine
  2. Contains elements of many tissues
74
Q

How common are sacrococcygeal Teratomas?

A

1/35,000 births

75
Q

Teratomas can arise from what? 3

A
  1. Sacrum or coccys
  2. Brain
  3. Gonads
76
Q

What are 4 types of sacrococcygeal teratomas?

A

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
Q

What is this an image of?

A

Sacrococcygeal Teratomas

78
Q

How does sacrococcygeal teratomas look like on ultrasound? 2

A
  1. Mass in rump or buttocks area adjacent to spine
  2. Displaces the pelvic structures and may compress the ureters causing hydronephrosis
79
Q

If there is AV shunting with Sacrococcygeal teratomas, what happens?

A

We may see signs of heart failure

80
Q

What does this image represent?

A

Sacral teratoma

81
Q

What is the prognosis for sacral teratomas? Solid masses have what kind of tendency? What size constitutes a c-section?

A
  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
Q

What is the DDX for sacral teratomas? 3

A
  1. Rectal duplication
  2. Anterior myelomeningocele
  3. Sacroma

DMST 315 OBGYN 3 (21 decks)

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