Spine and Pelvis

Question 1

Describe the ossification of the spine.

Answer 1

• 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.

Question 2

Describe the ossification of the pelvis.

Answer 2

• 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

Question 3

Describe the ossification of the acetabulum.

Answer 3

• completely cartilaginous at birth
• shape and depth determined by 8 y.o.
• fusion of 3 acetabular epiphyseal centres occurs between 17-18 y.o.

Question 4

What are the expected age for stage observations for the spine?

Answer 4

• 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

Question 5

What is the expected ROM for the kyphotic and lordosis curve in a child?

Answer 5

• kyphosis ROM is 20-45
• lordosis ROM is 20-55
• children become less flexible as they age, so ROM decreases as child ages

Question 6

What are some unexpected findings in the spine?

Answer 6

• Scoliosis
• Kyphosis
• Sheuermann’s Kyphosis
• Lordosis
• Back Pain

Question 7

What is scoliosis and what are the clinical signs?

Answer 7

• lateral curve of the spine, usually in the thoracic region

- signs of scoliosis include uneven shoulders, curve in spine and uneven hips

Question 8

How can you test for presence of scoliosis?

Answer 8

• 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

Question 9

What is kyphosis and what are the normal ROM for the kyphotic curve in a child?

Answer 9

• dorsally exaggerated thoracic curve
• normal kyphotic curve = 20-45 degrees
• can be hyper or hypo

Question 10

What may be the cause of kyphosis?

Answer 10

• in the older generation kyphosis may be caused by rickets, osteomalacia or TB of the spine

Question 11

How can you test for kyphosis and what should you do if it is found?

Answer 11

• look for gross differences in the appearance of the curve

- refer to paediatric physio or paediatrician (as pods can’t treat spine obviously)

Question 12

What is Sheuermann’s Kyphosis and what are the consequences of it?

Answer 12

• 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

Question 13

Is Sheuermann’s kyphosis painful?

Answer 13

• not normally severe pain due to flexibility of children
• more cosmetic concerns
• aching with prolonged sitting and standing in the mid-scapular region

Question 14

Is surgery indicated for Sheuermann’s kyphosis?

Answer 14

• only with recalcitrant pain, progressive deformity, kyphosis >70, or valid cosmetic concerns

Question 15

What is lordosis?

Answer 15

• increased lumbar curve

- can be hyper/hypo

Question 16

What is the normal ROM for lordosis curve?

Answer 16

• 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

Question 17

What are the most likely findings for back pain in children?

Answer 17

• spondylolysis, spondylolysthesis, Sheuermann’s kyphosis, disk herniation, slipped or # vertebral apophysis

Question 18

What are the red flags for back pain?

Answer 18

• 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

Question 19

What is the most common cause for back pain by age group?

Answer 19

• <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