neonatal hips and spine

ectodermal cells

give rise to spinal cord and neural tube

incomplete separation of neural tube and ectoderm

can lead to cord tethering, dermal sinus, or other defects

premature separation of neural tube from ectoderm

can lead to lipomas

failure of neural tube to fold and fuse

can lead to myelomeningocele

indications for neonatal spine exam

congenital anomalies, suspicious sacral dimple, soft tissue mass

less common indications for spine exam

lipomas, hydromyelia, myelomeningocele, myeloschisis

tethered cord is associated with

neonates with imperforate anus

33 vertebrae in C,T,L,S,C order

7,12,5,5,4

conus medullaris placement

between T12 and L1

filum terminale extends from _____ and should measure _____

conus medullaris to sacrum, <2 mm

_____, spinal cord tapers off into _____

inferiorly, conus medullaris

thecal sac

echogenic border of sac that serves as a protective membrane covering spinal cord

filum terminale variants

transient dilation of central canal, filar cyst, ventricular terminal

ventriculus terminalis

slight prominence or widening at caudal end of cord and often disappears withing first few months

ventriculus terminalis AKA

terminal ventricle or 5th ventricle AKA

terminal ventricle is found at _____ while filar cyst is found in _____

caudal end, filum terminale

cauda equina

lower nerve roots

level of tip of conus medullaris

L1/L2

tethered spinal cord sono sign

low-lying conus, caudal/posterior position, absent/dampened pulsations, thick filum terminale

dermal sinus

thin tract passing from skin to spinal canal, common in L/S junction

dermal sinus patients

risk of meningitis

pilonidal sinus

sacral/coccygeal position, associated with sacral dimple, and not connected to spinal canal or tethered cord

pelvic girdle

ischium, ilium, pubis

pubis symphysis

unites hip bones anteriorly

acetabular labrum

rim of fibrocartilage that makes acetabulum deeper, and provides support to femur head

labrum is _____ to femoral head and adjacent to _____

superolateral, ilium

____ of femur head is covered by ____

2/3, labrum

head of femur ossifies

3-8 months

hip instability may resolve _____ due to declining _____

4-6 weeks, maternal hormones

risk factors for hip displacement

frank breech, firstborn, family hx, oligohydramnios

hip displacement is most commonly seen in ____ and unilaterally on the ____

females, left hip

barlow maneuver

hip is adducted, downward and outward pressure is applied to dislocate hip

ortolani maneuver

hip is abducted and upward pressure to reduce dislocation

DDH signs

limitation of abduction, assymetrical skim folds, shortening of femur

galeazzi sign

shortening of femur in supine position

static technique

asses anatomic hip abnormalities

dynamic technique

assesses stability if hip by measuring movement

normal alpha angle

>60

normal beta angle

<55

mean femoral head coveragae between ____ % with a lower limit of ____%

54-56, 45

subluxated coverage measurement

<39%

dislocated coverage measurement

<10%

Graf Classifications: Type 1-4

normal, immature/ somewhat abnormal, subluxated, dislocated

hip displacement in coronal plane

femoral head gradually migrates laterally/superiorly with progressively decreased coverage

hip dysplasia in coronal plane

acetabular roof is irregular/rounded and labrum is defected superiorly becoming echogenic and thick

frankly dislocated hip in coronal plane

labrum may be deformed and contributes to irreducibility

frankly dislocated hip in transverse plane

hip is laterally/posteriorly displaced and normal”u” configuration cannot be obtained

pavlik harness

preferred treatment for hip displacement and can stabilize hip joint within 6-8 weeks of treatmentsxdddddddddddddddddddddddddddddddd