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39 Cards in this Set
- Front
- Back
... – defect in the pars interarticularis of the vertebra
Common after athletic activities requiring ... (gymnastics and lineman) back pain |
Spondylolysis
hyperextension |
|
Incidence of spondylolysis:
-Prevalence in children at 6 yo is ...-...% -At 18 increased to ...% -Risk factors include family hx, spina bifida occulta, scoliosis, Alaskan Eskimo heritage -Most common at ... *Area where you have highest amount of stress |
4-5
6 L5-S1 |
|
Presentation of spondylolysis:
-dull, ... back ache -worsening over a month -not associated with ... pain -exacerbated with rotation/... -rare neurologic symptoms (not a nerve impingment) -increase in training (frequency/intensity) |
unilateral
night hyperextension |
|
Radiographic imaging of spondylolysis:
Most can be diagnosed with ... Standing oblique x-rays Standing PA/lateral TLS Spot lateral at L-S junction Bone scan Thin cut CT scan, ... (gold standard-thin cut CT) MRI |
plain radiographs
SPECT |
|
Treatment of spondylolysis:
Stress reaction/fracture -Goal is ... of injury -Prevention of progression -Immobilize for 6-12 weeks with ... -Immobilization stopped with evidence of healing -Return to play when painless spinal mobility without ... spasm -No activities until 100% ... free |
healing
TLSO (thoracic lumbosacral orthosis) hamstring pain |
|
Surgical treatment of spondylolysis:
Indications/Options -... pain -... months non-operative treatment -Failed bracing -Gold standard is fusion ...-... -Repair of defect is recommended for ...-... -Wiring and screw techniques |
Persistent
6 L5-S1 L1-L4 |
|
... - Forward slippage of proximal vertebrae on distal vertebrae
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Spondylolisthesis
|
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Meyerding grades the spondylolisthesis as the percent ... displacement of the superior vertebra on the lower body.
Meyerding System -Grade I – 0%-...% -Grade II – 26%-50% -Grade III – 51-75% -Grade IV – 76%-100% -Grade V - >100% ... – all the way off. (will present with bent knees, tight hamstrings) |
anterior
Spondyloptosis |
|
Symptomatic:
Less than ...% slip -Conservative care -Consider anti-lordotic brace Slip from ...-...% -Activity restriction, bracing until pain free -Flexion exercises, hamstring stretching Slip greater than ...% -Surgical stabilization |
25
25-50 50 |
|
Surgical indications:
Pain greater than ...-... months Unrelieved with ... and immobilization ... of spondylolisthesis Slip greater than ...% ... deficits |
6-12
rest Progression 50 Neurologic |
|
Postural Round Back
Thoracic Kyphosis without ... changes Forward bend increases kyphosis but no sharp ... as in Scheuermann’s disease TX- hyperextension exercise program-strengthen those muscles in the back-make them aware of not slouching |
vertebral body
angulation |
|
... - Avascular necrosis of vertebral endplate
-Disease of adolescents -At least 5 deg anterior wedging of a least 3 adjacent thoracic vertebrae -8% of population affected -Equal gender distribution -Commonly diagnosed in early adolescence -No ... plane (scoliosis) deformity -Significant ... plane deformity -Thoracic kyphosis *Rigid on attempts at correction -... hyperlordosis |
Scheuermann’s Kyphosis
coronal sagittal Lumbar |
|
Etiology of Scheuermann’s Kyphosis is ...
Genetic Growth hormone Mechanical factors Altered ratio of collagen to proteoglycans Juvenile osteoporosis Defective cartilage endplates |
uncertain
|
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Scheuermann’s Kyphosis presentation:
Adolescents ...-... years old – during growth spurt (opportunity to act the quickest) Increasing spinal curvature ... deformity -Pain is common if initial presentation in adults Associated ... and scoliosis Rare ... complaints |
12-16
Painless spondylolisthesis neurologic |
|
Conservative treatment for SK:
Physical therapy -Hamstring strengthening -Trunk extensor strengthening ... for pain Bracing -Poor compliance -... brace for 23 hours a day for 1-2 years -Limited outcomes studies |
NSAID’s
Milwaukee |
|
Surgical indications for SK:
Intractable ... -More common in adults Curves >... degrees Cardiopulmonary or neurologic compromise |
pain
75 |
|
Key points for SK:
Radiographically defined as presence of ... or more adjacent vertebrae with at least ... degrees of anterior wedging Adolescents generally present with ... progressive deformity and cosmetic complaints, while adults present with ... |
3
5 painless pain |
|
...:
Lateral Deviation and Rotation of a series of vertebrae from the midline anatomic position Lateral Curvature of the spine exceeding 10° |
Scoliosis
|
|
What is the most common type and presentation of scoliosis?
|
Adolescent idiopathic scoliosis
Convex right thoracic (rib hump on the right) |
|
Etiology of scoliosis:
-Majority have ... etiology -Scoliosis is a ..., NOT a diagnosis -Must rule out neurological and structural causes -... scoliosis: Fixed deformity that does not correct on lateral bending -severe pain, convex left thoracic curve and abnormal neurologic exam point to ... cause for spinal deformity |
unknown
physical sign Structural secondary |
|
...% of Scoliotic curves are Idiopathic (occur without a known cause)
30% of patients have family members with significant scoliosis *No gene has been located (probable multigene dominant condition with variable phenotypic expression) |
80
|
|
Infantile idiopathic scoliosis:
-occurs birth to ... yrs old -... curve most common -boys ... girls -The earlier it is diagnosed and the more aggressive the deformity, the more likely that tx will be necessary -90% spontaneous resolution -girls with ... curve poor prognosis |
3
left thoracic > convex right |
|
Infantile idiopathic scoliosis:
Rib vert angle difference less than ... deg has low likely hood of progression |
20
|
|
Infantile Idiopathic Scoliosis:
...% progress, ...% resolve, ...% do not change If cobb curve < ... degrees, observation if between ...-... degrees, brace if >... degrees, neuro/MRI work up, instrumentation combined with anterior and posterior fusion |
50, 10, 40
25 25-35 35 |
|
Juvenile Idiopathic scoliosis:
Occurs ... to ... Years of Age Female to Male Ratio ... 70% require treatment 50% will eventually need corrective surgery 50% need bracing |
3 to 10
4:1 |
|
Adolescent idiopathic scoliosis
-10 years of Age - Skeletal ... (Closure of epiphyses) -Female to Male Ratio ... (require treatment) -Convex ... (most common) *If you see convex ..., start thinking of other things |
Maturity
9 : 1 Right Thoracic left |
|
Clinical screening:
... Test: Definitive Clinical Test * Structural Scoliosis: The vertebrae rotates to the convex side of the lateral curvature, spinous process rotates toward the concavity. ... bending: To determine if the curve goes away when the patient bends toward the side of the rib hump * Structural Scoliosis is a fixed deformity that ... correct on lateral bending. ...: Used during Forward Bending to assess angular prominence * Screen if trunk rotation is >7° * Look for the rib hump on the convex side of curve |
Adams Forward Bending
Lateral does not Inclinometer |
|
The majority of Scoliosis is detected between the age of 10-15yrs
Curvature deformities are 3-5 times more likely to progress and produce subjective symptoms in .... Significant growth occurs 6 -12 months before ... -Bracing works better if they have not had their ... yet Curves of 11° or more are seen in 2% of early adolescents -0.2% of these curves will worsen to need tx |
girls
menarche period |
|
Adolescents with scoliosis are usually ...
|
asymptomatic
|
|
Non Treatment complications:
Degenerative Spinal Arthritis: Loss of ... height, osteophytes, intersegmental instability Cardio Pulmonary Complications: -seen in progressive scales beginning <5 years of age - >75 degrees compromises ... functions - Thoracic curve >50 degrees compromises ... functions - Cor Pulmonale thoracic curves > 90° |
disk
cardiovascular respiratory |
|
Indications of likely progression:
~ Curves > ... degrees are more likely to progress if Risser 1-2, 68% ~ Curvature Pattern : Double primary, lumbar primary curvature ~ Gender: ... > Male ~ Age: ... Maturity ~ Onset of Menarch (early onset): increased risk for growing girls with established curve of >... degrees or more |
20
Female Skeletal 11 |
|
MRI:
Identifies ... abnormalities (Arnold-Chiari malformation and syringomyleia) Perform MRI on Infantile Scoliosis with Cobb angle > ... deg Neural Axis abnormality in 21%-50% Adolescent idiopathic thoracic convex L |
spinal cord
20 |
|
skeletal maturation:
Iliac Crest Epiphyses (... Sign) : *Begins laterally at ASIS and progresses medially to PSIS. * Ossification of Iliac apophasis If greater than 3, we ... brace them. (there’s not much growing left to do) |
Rissers
won’t |
|
... is most effective and most commonly used
*... Brace: Cervicothoracolumbosacral orthosis *... Brace: Thoracolumbosacral orthosis -In growing children, progression can be arrested, but not ... with a body brace -Brace when curves are flexible, skeletally immature, between 25-40° or when progressive -Most effective in Risser 0,1,2 and apex at T-8 and below |
Orthosis
Milwaukee Boston improved |
|
Milwauke CTLSO if apex at or above ...
Boston TLSO if apex at or below ... Full-time wear of 16-23 hours until skeletal maturity, then wean off for 6-12 months: Brace Success is 80% Expect an initial 40-50% improvement, followed by a gradual loss with the end result = curve at presentation |
T-7
T-8 |
|
Surgery:
Indications: -When underlying abnormality is painful and can be treated -When rapid progression is occurring on an immature spine -When the curve is > ... deg. with a great deal of rotation and translatory shift Goal: -Restore the normal contour of the back from both the front view and side view -To fuse as ... segments as possible and to allow maximal normal rotation |
40
few |
|
Surgery:
... Spinal Instrumentation with Fusion: -Has been used for over 35 years with success -Gold Standard for majority of thoracic and double major curves -Loss of lordosis or fusion with instruments below ... is a risk factor for significant low back pain (try not to fuse below this) -Post fusion radiographs show < in Cobb Angle of around 35% |
Posterior
L-3 |
|
surgery:
... Rods: Two rods placed on either side of the spine and anchored to bone by hooks with sequential distraction of concavity and compression of convexity ... Systems: Help maintain lumbar lordosis and thoracic kyphosis ...: Combined with posterior systems for selected indications such as adult scoliosis and high degree curves with rotation |
Harrington
Segmental Pedicle Screws |
|
Surgery:
... Spinal Fusion with Instrumentation -Select thoracolumbar curves with apex at T-11,12 and L-1 - Difficult Lumbar curves of 40-60° -... phenomenon- continued anterior growth under a solid posterior fusion - ASF with PSF if severe deformation >75° and ... prevention - (girls <10 years, boys< 13 years) Advantages: Decreased levels of fusion while sparing lower lumbar levels Disadvantages: Increased lumbar kyphosis, thoracic hyperkyphosis, rod breakage(pseudoarthrosis) |
Anterior
Crankshaft crankshaft |