Neonatal Spine and Hip

Overview of Spine and Hip Lecture

• Focus on spine and hip ultrasound training for pediatric patients.

• Challenges with teaching due to the timing of clinical rotations.

• Common clinical practice trends focus on hips in ultrasound evaluation.

Anatomy and Embryology of the Spine

• Formation of the Spine: Comparable to a zipper that should close completely.

  • Spinal Defects: Spina bifida can occur when the spine fails to close properly.

  • Importance of understanding how the spine develops in embryos.

Vertebrae Count

• Memory Aid: **7 AM, 12 PM, 5 PM **

  • 7 cervical vertebrae (breakfast)

  • 12 thoracic vertebrae (lunch)

  • 5 lumbar vertebrae (dinner)

  • 5 sacral vertebrae (dessert)

  • 1 coccyx (midnight snack)

Spinal Cord Anatomy

• Key Structures:

  • Conus Medullaris: Ends above L2 or L3.

  • Cauda Equina: Bundle of spinal nerves extending from the conus medullaris.

  • Ultrasound Landmarks: Identify vertebral body, transverse processes, and spinal processes.

Protocol for Spinal Ultrasound

• Position the baby prone or in left lateral decubitus depending on conditions.

• Use high-frequency transducer (6-15 MHz).

  • Techniques to visualize specific regions of the spine effectively.

Sonographic Findings in the Spine

• Spinal Cord Appearance:

  • Hypoechoic in the center with hyperechoic peripheral margins.

  • Central canal also appears hyperechoic.

  • Identify echogenic nerve roots and recognize normal variations.

• Key Measurements: Conus medullaris should end above L3 to prevent concerns regarding spinal cord issues.

Pathologies and Anomalies

• Spinal Dysraphism: Anomaly group indicating malformations of the spine and spinal cord.

  • Deastomatomyelia: Two spinal cords split posteriorly.

• Tethered Cord Syndrome: Involves tissue connections restricting spinal cord movement, often linked to spinal bifida and surface abnormalities.

  • Ultrasound visualization focuses on conus medullaris and associated abnormalities.

Spinal Masses and Tumor Terminology

• Importance of differentiating between intramedullary (within spinal cord) and extramedullary (outside spinal cord) masses.

• Common findings include lipomas, hemangiomas, and other tumors associated with surface abnormalities like sacral dimples.

Hips and Developmental Dysplasia

• Developmental Dysplasia of the Hip (DDH): Spectrum affecting proximal femur and acetabulum.

  • Identify subluxation (partial dislocation) and total dislocation.

• Associated Conditions: Includes neuromuscular disorders, congenital torticollis, and family history.

• Risk Factors: More common in females, breech presentations, first-borns, oligohydramnios.

Imaging Techniques for Hip Evaluation

• Ultrasound preferred under 6 months. X-ray for older infants to confirm ossification.

• Clinical Maneuvers: Barlow's and Ortolani's tests.

  • Manual assessment to detect dislocation or relocation of hips during examination.

Protocol for Ultrasound Evaluation of Hips

• Focus on high-resolution images with transducer orientation appropriate for coronal and axial views.

• Main structures to visualize include the acetabular labrum, triradiate cartilage, and femoral head.

• Key Angles: Measure alpha (normal ≥ 60°) and beta angles (normal < 55°).

• Abnormal findings require follow-up and interpretation from experienced personnel.

Treatment Options for Hip Dysplasia

• Treatment: Corrective measures like Pavlik harness or spica cast.

• Close monitoring to prevent avascular necrosis due to compromised blood supply.

Additional Pathologies Related to Hips

• Avascular Necrosis: Lack of blood flow leading to necrosis in the hip joint, potentially requiring surgical intervention.

Concluding Remarks

• Encouragement for hands-on practice and reliance on experienced staff in clinical settings.

• Open for questions; sharing of recorded lectures for reference.