Week 7 Trunk and Spine Flashcards
*Epedemiology of Back pain in children and adolescents
- Population-based studies have demonstrated that low back pain is common in children and adolescents.
- Factors that do not seem to contribute
to back pain in school age children include:
Heavy back pack
Computer use
Physical activity - Low back pain is more common in school-age children:
high levels of psychosocial difficulties,
conduct problems, or
other somatic disorders.
*Describe various causes of Acute/chronic LBP in Children and adolescents
ACUTE =
- herniated discs,
- vertebral fractures - mc from MVA; falling from height
- muscle strains - physical activity, no radiating pain
- A slipped apophysis similar Sx to a herniated disc,
with pain radiating down the legs.
CHRONIC = - developmental problems = Scheuermann's disease inflammatory spondyloarthropathies, - psychological problems.
*Discuss the management of a child/adolescent with scoliosis dirrerenciating between idiopathic structural soliosis and non-structural scoliosis
Considerations: Skeletal maturity Growth potential Curve magnitude (>40 degree Cobb’s angle) Co-existing conditions (pathology, epilepsy) CP status Psychological factors Risk v benefits
IDIOPATHIC STRUCTURAL SCOLIOSIS
>25 degrees will be monitored by ortho team.
25-40 conservative Rx (bracing and exercise)
>40 is surgical candidate. (especially if progressive)
IDIOPATHIC NON-STRUCTURAL SCOLIOSIS
- Correct any LLD / other underlying problem
- Promote physical activity (general fitness)
- Specific stretch and strength activity if impairments
found
- Monitor child’s growth and any progress of curve
- Usually disappear when underlying problem treated
*Describe the various types of scoliosis
Classification
By age
= Infantile onset
*Define Scheuerman’s Disease
Growth disorder of the spine with narrowing of the intervertebral discs, wedge vertebrae formation, collapse of endplates and kyphosis in the affected area.
=> TS, LS or thoracolumbar
*Discuss Etiology of Congenital malformations of the spine
-MC acquired during pregnancy.
- FHx only around 1% of cases - usually associated
with multiple anomalies.
- MC causative factor is assumed to be toxic damage during the pregnancy.
- FOLATE deficiency appears to play a role in the development of MYELOMENINGOCELE .
*Define spinal injuries
Fractures of the vertebral bodies and/or vertebral
arches, ligament injuries and/or dislocations of the
axial skeleton with or without neurological lesions.
Spinal Growth
Ossification
- Begins late fetal period and continues after birth
- Primary centres of ossification – spinous, transverse
and articular processes.
- Secondary centres – vertebral body, spinous &
transverse processes, ribs
0-3 = RAPID growth
3- onset of puberty = relatively LINEAR growth
During adolescent growth spurts = RAPID growth
When do you refer a confirmed scoliosis patient?
All types and all degrees above 10 (really 20deg) should be referred
to ortho team for review and ongoing monitoring.
*Scheuerman’s Disease Etiology
MECHANICAL factors = adolecent athletes tall girls >6 foot
ENDOGENOUS factors = more frequent in families - not conclusively proven
POSTURE = increased kyphosis not conclusive
PSYCHOLOGICAL factors
OSTEOPOROSIS = decreased bone density “chicken or egg”
*Scheuerman’s Disease clinical features
An adolescent presenting with SEVERE back pain with NO Hx OF TRAUMA one should always consider the possibility of lumbar or thoracolumbar Scheuermann’s disease.
*Scheuerman’s Disease prognosis
= Fixed, thoracic kyphoses of LESS than 50° do
not represent a problem in adulthood, back pain is no more common or intense than in normal individuals.
= Cosmetically visual deformity is psychological burden (particularly for women).
= Fixed, thoracic kyphoses of MORE than 50°, back pain is no more frequent, but is likely to be MORE INTENSE than in normal individuals.
= Lung function may be impaired in very severe kyphoses.
= Kyphosis of more than 70° can also be progressive in adulthood.
*Scheuerman’s Disease management
Tx Options =
BRACING: Kyphosis >50 °, Patient has growth potential;
- Provide stabilisation + may reduce in younger pop.
SURGERY: Kyphosis >70 °; Mainly for cosmetic reasons
What are the radiologic features + associated diseases of Scheuermann’s Disease?
- wedge vertebrae
- narrowed IVD space
- schmorl’s nodules
- apophyseal ring herniation
Associated Diseases
= Scoliosis
= Spondylosis
*spinal injuries Etiology
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*spinal injuries clinical features
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*spinal injuries prognosis
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*spinal injuries management
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*Congenital malformations of the spine - classification
NEURAL TUBE defects,
defects of SEGMENTATION
defects of FORMATION
*Congenital malformations of the spine - NEURAL TUBE defects + example of MC
- neural tube fails to completely close during the fourth week of embryonic development.
- Structures overlying these midline abnormalities are severely affected and may be unable to form.
*Congenital malformations of the spine - defects of FORMATION
• absence of a structural element of a vertebra.
• Any region of the vertebral ring may be
affected:anterior, anterolateral, posterior, posterolateral
and lateral.
• Hemivertebrae
• Wedge vertebrae
Congenital malformations of the spine - Associated Deformity
- Fusion of the ribs - Spinal dysraphism = Around 20–30% of patients with congenital malformations show intraspinal anomalies. - Pulmonary dysfunction - Renal Malformations - Heart defects (7%) - Sprengel deformity (6%), - Cleft lip and palate (4%) - Shortening of the extremities (4%), - Clubfoot (13%) and - A talus verticalis (1% )of cases.
*Congenital malformations of the spine - clinical features, prognosis,
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*Congenital malformations of the spine - defects of SEGMENTATION
BLOCK VERTEBRAE = bilateral failure of segmentation
UNILATERAL BAR = unilateral failure of segmentation
UNILATERAL BAR & HEMIVERTEBRA = unilateral failure of segmentation
