Unit 4 - Surgical Management of Spine Flashcards
natural history of scoliosis after maturity
70deg have cardiopulmonary sxs
50-75 deg progress 1 deg/year
Risser sign
indication of skeletal maturity using ossification of iliac crest (5 skeletally mature)
rib/paraspinal hump side
hump on same side as curve
syrinx
CSF in spinal cord
atypical radiographic findings in scoliosis
left thoracic curve, sharply angled curves, very large curve, congenital bony abnormality
Cobb angle
measurement of degree of scoliosis
long tract sign
upper motor neuron symptoms (clonus, spastisity)
bracing indications in scoliosis
variable based on risser number, at least 25 deg, sometimes just watch for progression
brace types
TLSO - for thoracic curves (boston brace)
CTLSO for double thoracic curves (milwaukee brace)
surgical indications for scoliosis
> 45 deg in adolescents
50 in mature
stiff, large kyphosis
inability to control progression with brace
general post-op activity after scoliosis surgery
possible brace (posterior approach) walking day after surgery no twisting or bending no strenuous activity for 3 months no contact sport until 6 months activity as tolerated after 1 year
dysraphism
general term for neural tube defect
degrees of spina bifida
spina bifida occulta - no extrusion of meninges, not a clinical problem, present in 15% of population
Meningocele - saccular herniation of meninges without nerve tissue
Myelomeningocele - saccular herniation with nerve tissue, high risk of scoliosis
Rachischisis - not even skin covering nerve root and spinal cord, short life expectancy
often surgery with goal of preventing progression of deformity, when applicable
often have latex allergy
scheurman’s kyphosis
larger and more structural than postural kyphosis (hunchback), may be painful risk of schmorls nodes stabilizes in adulthood >100 deg causes pulmonary restrictions surgery if >80 deg
Spondolosis
degeneration of spine