Module 11.1 : Spinal Pathology

Question 1

Development of spine

Answer 1

• each vertebrae develop from 3 ossification centers
  
  • centrum
  • neural processes

Question 2

What does the centrum form

Answer 2

• central portion of vertebral body

Question 3

What does the neural processes form

Answer 3

• pedicles
• transverse processes
• laminae
• spinous process
• posterolateral part of vertebral body

Question 4

Ossification

Answer 4

• ossification is not complete in than laminae until 18 weeks
• can potentially miss a small spina bifida before the

Question 5

Risk of NTD increase with

Answer 5

• valproic acid (meds for seizures)
• maternal diabetes
  + type 1 or 2
• folic acid deficiency
• history of spinal defects
  + previous pregnancy
  + family history

Question 6

Spina bifida

Answer 6

- defect in bones structure of spinal canal that may result in Bernita ion of its content 
  \+ meninges 
   \+ CSF
   \+ neural tissue
- neural tube defect (NTD)

Question 7

Other NTD

Answer 7

• encephalocele
  + brain herniation
• anencephaly
  + missing all = brain and and skull

Question 8

Variations of spina bifida

Answer 8

Spina bifida occulta

Spina bifida Alperta

Question 9

Spina bifida Occulta

Answer 9

• involves only the deeper layers
• may only see a skin dimple or patch of hair on the skin
• closed defect
• less common

Question 10

Spina bifida aperta

Answer 10

• involves all layers from dura to skin
• open defect
• more often
• two types
  + meningocele
  + myelomeningocele

Question 11

Spina bifida aperta - meningocele

Answer 11

• contains meninges and CSF

Question 12

Spina bifida aperta - myelomeningocele

Answer 12

• contains meninges, CSF, and neural tissue

- more common

Question 13

Screening for NTD

Answer 13

• quad screen at 16 weeks
• maternal serum alpha fetal protein
• AFP produced by liver
• crosses placenta and varies with gestational age
• AFP is elevated with NTD not covered by skin

Question 14

Other causes of elevated AFP

Answer 14

- abdominal wall defects
  \+ omphalocele
  \+ gastrodchisis (bowel outside)
- twins
- fetal death
- urinary obstruction
- cystic hygroma
- incorrect dates

Question 15

NTD in lumbar spine

Answer 15

- Meckel Gruber syndrome
   \+ encephalocele
   \+ polycystic kidneys
   \+ polydactyly
- T18
- triploidy

Question 16

What is a neural tube defect

Answer 16

- spinal dysgraphism 
   \+ abnormal closure of spine
- rachischisis
   \+ another name for spinal dysraphism
   \+ failure of fusion of vertebral arches

Question 17

Other system affected by NTD

Answer 17

• legs
  + club foot
  + hip dislocation (not seen on US)
• causes by imbalance of muscular activity due to nerve involvement of NTD
• nerves exposed to amniotic fluid get damages

Question 18

Spinal NTD on US

Answer 18

• splayed laminae
• protruding mass or cyst
• look for associated Arnold Chiari II and ventriculomegaly

Question 19

What plane is assessment on spine done best in

Answer 19

Transverse

Question 20

Prognosis of NTD

Answer 20

• depends on location and extent of neural tissue involved

- more superior the worse off

Question 21

Ineincephaly

Answer 21

• special case of dyraphism involving back of cranium and c spine
• Inein refers to name of neck
• segmentation errors of upper spine shortens neck and head becomes drosifelxed
• known as star gazing position
• associated with anencephaly
• hydrocephaly ventricle not draining

Question 22

Scoliosis

Answer 22

• lateral curvature of spine

Question 23

Kyphosis

Answer 23

• exaggerates curvature of spine in sagittal Plane

Question 24

Scoliosis and kyphosis associated with

Answer 24

• amniotic band syndrome
• skeletal dysplasia
• VACTERL
• caudal regression syndrome

Question 25

VACTERL sequence

Answer 25

- Vertebral (dysraphism) - Anal (atresia) - Cardiovascular - Tacheo-Esophageal (fistula or atresia) - renal - Limb (radial Ray) + get echo and look at kidneys - associated with caudal regression - prognosis depends on severity and extent of involvement

Question 26

Caudal regression

Answer 26

- range of abnormalities of the spine + absence of part of sacrum up to absence of lumbar spine - increased risk with + type 1 maternal diabetes and insulin dependant diabetes (IDDM)

Question 27

Sirenomelia (mermaid syndrome)

Answer 27

- absence of sacrum - fusion of legs - re tail atresia - renal dysgenisis or agenisis - oligohydroamnious (no kidneys no urine) - prognosis = all die in infancy - MOST SEVERE CAUDAL REGRESSION

Question 28

Sacroccygeal teratoma

Answer 28

- contains elements of many tissue - teratomas can arise from sacrum or coccyx the brain or gonads - 4 types

Question 29

4 types of teratomas

Answer 29

- I external mass predominant (most common) - II external mass with internal components (nest common) - III internal mass predominant with smaller external component (least common) - IV presacral mass (internal only) (second least common)

Question 30

Teratomas on US

Answer 30

- mass on rum area adjacent to spine - most are solid or mixed = malignant - cystic = benign - May see calcification - displaces pelvic structures may compress ureters = hydronephrosis - if AV shunting May see heart failure

Question 31

Teratoma prognosis

Answer 31

- depends on size of mass and severity of structure displacement - solid mass more malignant - if > 4.5 cm cesarean done - DDx = rectal duplication, anterior myelomeningocele, or sarcoma