Patho - Development Disorders

Scoliosis is best described as

abnormal LAT curvature of the spine

A scoliosis curve to the right is more common in

thoracic spine

A scoliosis curve to the left is more common in

lumbar spine

A scoliosis curve that rotates around the axis of the spine can cause

rib cage deformity

Scoliosis is typically associated with

kyphosis / lordosis

Functional Scoliosis aka

Postural Scoliosis

Functional (postural) scoliosis is secondary to factors other than

vertebral involvement

Which of the following is not a secondary factor of functional (postural) scoliosis?

good posture

A functional (postural) scoliosis is straighten when paced in ______ or ______ to side of ________.

forward bend; IPSA FLX; VEXITY

Structural scoliosis is FIXED curvature associated with

vertebral ROT &

asymmetry of ligamentous support

Which of the following is not associated with structural scoliosis?

unwedged vertebrae

Which of the following is most commonly associated with structural scoliosis?

idiopathic

Structural scoliosis maintain position irrespective of whether the spine is

upright, forward bend, or IPSA FLX → side of CONVEXITY

The lumbar curve corrects as the patient bends to the right, this is considered

a nonstructural curve

The thoracic curve persists as the patient bends to the left, this is considered

a structural curve

The direction of the scoliosis curve is based on the direction of the

convexity of the curve

The top vertebrae are those who surface is

most tilted

The bottom vertebrae are those who surface tilts

most toward the curvatures concave side

Scoliosis is typically seen with

one primary curve + secondary curve to balance the body

For scoliosis can exist with 2 _______ curves (R thoracic/L lumbar)

primary

Scoliosis involved with rotational deformity occur on the

convex side

Scoliosis involved with rotational deformity may not be observed in _________ but is always apparent in _______.

standing; forward bend

What are the four classifications of scoliosis?

idio-, osteo-, myo-, and neuro-

What percentage of children present with scoliosis?

0.4-5.5%

What percentage of children present with scoliosis require some type of treatment?

25%

33% of scoliosis occurs in the context of

a primary neuromuscular disorder

Neuromuscular scoliosis often secondary to

imbalance or asymmetry of muscle thru trunk / spine

Which of the following is not a pathological change caused by a scoliosis?

lig/tissue lengthening on concave

What method is used to measure scoliosis?

Cobb method

Which of the following statements is not true about the cobb method?

angle formed by two parallel lines

_______ scoliosis is defined as a curve <20 and is rarely symptomatic.

mild

______ scoliosis is defined as a curve >60 and is associated with pulmonary insufficiency, degenerative spinal arthritis, disk disease, vertebral subluxation, sciatica.

severe

Which of the following is not true about back pain associated with scoliosis?

Less frequent in adults.

Which of the following is not a factor of back pain in scoliosis?

muscle instability / calf imbalance

What are common characteristics of scoliosis?

asymmetric shoulder/pelvic positioning

Scoliosis can be diagnosed either by

imaging or cllinician

What angle must the curve be in order to be considered scoliotic?

>10

10º scoliotic curve =

mild and rarely symptomatic

60º scoliotic curve =

severe

What is the Adam’s Forward Bend Test?

patient bend forward, assess for symmetry.

Which of the following statements is not true about the scoliometer?

Measure angle of trunk flexion

What is the key for treatment of scoliosis?

prevention (slow down curve progression)

If the curve is <25,

observe/monitor every 4-6m

A curve 25-45 involves

spinal orthoses

What is the goal of spinal orthoses?

prevent further or reduced current amount of curvature

Spinal orthoses serves as a passive restraint system to maintain

curvatures w/in 5 degrees of the curve measurement at time of initial applications

A curve > 45 involves

surgery (spinal rods)

Match these braces with the following uses

1. best with curvature apex lower thenT9/10

2. For idiopathic scoliosis with thoracic hypokyphosis

3. Best with curvature at T8 or above

4. For idiopathic curves fabricated in maximum SB correction

3, 1. 2, 4

milwaukee brace

Boston brace

Lyon brace

Surgery for scoliosis involves

Fusion w/ POST seg spinal instrumentation

Postural scoliosis resolve as soon as

the primary problem is addressed

If the structural scoliosis curvature is less than 40’ the risk of progression is

small

If the structural scoliosis curvature is greater than 50 the spine is

biomechanically unstable

In structural scoliosis curvature will increase at rate of

1º/yr without treatment

Spina Bifida is a(n)

a congenital defect where there is a closure failing of the neural tube

What are the three categories spina bifida is typically broken down into?

Spina bifida occulta, Meningocele, Myelomeningocele

Spina bifida occulta =

Incomplete fusion of the posterior vertebral arch

Meningocele =

External protrusion of the meninges

Myelomeningocele =

Protrusion of the meninges and spinal cord

Spina Bifida typically occur in

lumbosacral area

What is the incidence rate of Spina Bifida?

3.4 per 10,000 live births (has been declining)

Why has overall incidence of spina bifida have been declining?

Prenatal screening / Improved nutrition (folic acid)

Need increased folic acid during at least

the first 6 weeks of pregnancy

Which of the following is not a factor of spina bifida?

Social status

Neural groove starts to develop about

20 days after conception

By day 23 the formation of

neural tube is compete EXCEPT opening at each end

By day 27, both ends of the neural tube are

closed off

Any closing failure of neural tube thru/out this time period

can result in

a NTD of some sort

In spina bifida, 75% of vertebral defects are located in

lumbosacral region at L5-S1

In spina bifida, motor dysfunction depends on

level of involvement / not evenly distributed

Spina Bifida Occulta does not

protrude through the skin

Spina Bifida Occulta is NOT accompanied by

Hard fatty deposits

Spina bifida occulta typically has no neuromuscular dysfunction except for

bowel/bladder disturbances or foot weakness

Meningocele is rarely associated with

neurological impairment

Myelomeningocele is almost always associated with

neurological impairment

Which of the following is not a characteristic of myelomeningocele?

Hypertonia

Which of the following characteristics is present in ~90% of children born with a myelomeningocele?

Hydrocephalus

Which motor spinal cord segment is involved

≤ T10

Which motor spinal cord segment is involved

T12

Which motor spinal cord segment is involved

L1-L2

Which motor spinal cord segment is involved

L3-L4

Which motor spinal cord segment is involved

L5

Which motor spinal cord segment is involved

S1

Which motor spinal cord segment is involved

S2-S3

Meningocele and Myelomeningocele is typically detected prenatally with

US and serum AFP (alpha-fetoprotein) testing

Spina bifida occulta is generally detected at

birth

In utero Spina bifida occulta is

Not detectable

Postnatally Meningocele and Myelomeningocele is obvious on

physical examination

transillumination of the protruding sac

Prenatal surgery for Meningocele and Myelomeningocele involves a

Closure of the tube reduces risk of hydrocephalus from 90% to 59%.

Other than surgery, what other treatments are used for spina bifida?

Bowel and bladder management / Addressing individual symptoms

The prognosis of spina bifida varies with degree of accompanying neurologic deficit. The higher the ___________ the worse the prognosis.

Myelomeningocele

Approximately 2/3 children with myelomeningocele have an IQ that falls in

normal range (after shunting for hydrocephalus)

Children with myelomeningocele typically have a delay in achieving ambulation is

normal (but goal is ambulation by 7 years old)

Developmental Dysplasia of the Hip (DDH) is a common disorder affecting

infants and children

DDH can be U/L or B/L and occur in which 3 forms?

Unstable hip dysplasia, Subluxation, Complete dislocation

Unstable hip dysplasia

Hip is positioned normally but can be dislocated by manipulation

Subluxation

Femoral head remains in contact with acetabulum

Complete dislocation

Femoral head is totally outside the acetabulum