Spine and Pelvis Flashcards
Describe the ossification of the spine.
- ossification of vertebrae becomes evident in 8th week of pregnancy
- at birth each vertebrae consists of 3 parts joined by cartilage
- three parts of vertebrae fuse by 3-5 y.o.
- starts at lumbar spine and continues up to cervical
- ossification complete at 25 y.o.
Describe the ossification of the pelvis.
- starts as 3 separate bones (ilium, ischium and pubis)
- in first few weeks of the embryonic phase all elements of the hip and pelvis are distinguishable
- ossification of ilium begins at 9 weeks
- ossification of ischium begins at 16 weeks
Describe the ossification of the acetabulum.
- completely cartilaginous at birth
- shape and depth determined by 8 y.o.
- fusion of 3 acetabular epiphyseal centres occurs between 17-18 y.o.
What are the expected age for stage observations for the spine?
- fetal-newborn: kyphotic
- newborn- 6 months: kyphotic with cervical spine developing due to tummy time
- 6 months-10 months: lumbar lordosis develops due to rocking and crawling
- 10 months+: early walking requires 3 curves
- 6-7 y.o. - all three curves present
What is the expected ROM for the kyphotic and lordosis curve in a child?
- kyphosis ROM is 20-45
- lordosis ROM is 20-55
- children become less flexible as they age, so ROM decreases as child ages
What are some unexpected findings in the spine?
- Scoliosis
- Kyphosis
- Sheuermann’s Kyphosis
- Lordosis
- Back Pain
What is scoliosis and what are the clinical signs?
- lateral curve of the spine, usually in the thoracic region
- signs of scoliosis include uneven shoulders, curve in spine and uneven hips
How can you test for presence of scoliosis?
- scoliosis sometimes may not be visually obvious until a child is taller
- good way to test is to run two fingers down either side of the spine
What is kyphosis and what are the normal ROM for the kyphotic curve in a child?
- dorsally exaggerated thoracic curve
- normal kyphotic curve = 20-45 degrees
- can be hyper or hypo
What may be the cause of kyphosis?
- in the older generation kyphosis may be caused by rickets, osteomalacia or TB of the spine
How can you test for kyphosis and what should you do if it is found?
- look for gross differences in the appearance of the curve
- refer to paediatric physio or paediatrician (as pods can’t treat spine obviously)
What is Sheuermann’s Kyphosis and what are the consequences of it?
- anterior wedging of 3 consecutive vertebrae
- tends to affect much older children and boys in particular (15 y.o.)
- consequences include hip pain, pelvis pain and LLD
Is Sheuermann’s kyphosis painful?
- not normally severe pain due to flexibility of children
- more cosmetic concerns
- aching with prolonged sitting and standing in the mid-scapular region
Is surgery indicated for Sheuermann’s kyphosis?
- only with recalcitrant pain, progressive deformity, kyphosis >70, or valid cosmetic concerns
What is lordosis?
- increased lumbar curve
- can be hyper/hypo
What is the normal ROM for lordosis curve?
- 20-55 degrees - changes across their timeline
- when children start to WB they are very flexible so they have large lordosis - reduces as they age
What are the most likely findings for back pain in children?
- spondylolysis, spondylolysthesis, Sheuermann’s kyphosis, disk herniation, slipped or # vertebral apophysis
What are the red flags for back pain?
- night pain, referred pain, night pain in bone (tumour or infection until otherwise proven)
- young children and toddlers are less likely to exaggerate their symptoms, therefore most likely a pathological reason for their back pain
What is the most common cause for back pain by age group?
- <4 y.o. most likely infection or neoplasm
- <10 y.o. most likely diskitis, vertebral osteomyelitis or neoplasm
- > 10 y.o. most likely pain secondary to trauma or overuse
