Normal variant- intrasutural bones
Very prominent or numerous-abnormal/
look for other skeletal findings
Involves- lambdoid, posterior sagittal, temporosquamosal sutures
NOT related to increased intracranial
pressure. Multiple lacunae- lakes scattered lucencies
Resolves by 6 months of life-ossification
TRAUMA-SOFT TISSUE LAYER:
Subcutaneous
Subgaleal
Subperiosteal
CEPHALOHEMATOMA
2% of all deliveries
ST mass bounded by suture lines. Associated fracture in 1%
Mass...Ca++ in 10-14 days, resolves in months
Permanent residual sclerosis
Subcutaneous blood or fluid
STS crosses sutural boundaries
Resolution within few days
PEDIATRIC SKULL FRACTURES
25 percent of pediatric skull fractures are depressed type
One third of depressed fractures have associated dural tear
Parietal(46%) > Frontal(33%) > Occipital >Temporal
LEPTOMENINGEAL CYST
Complication 1% skull fractures
Encapsulated fluid collections arachnoid space surrounded by adhesions
Children under age three have tighter dural adherence to skull predisposing to tear
anterior and posterior
Assymetric ossification of arches and bodies
neural arch ossification- cervical
Vertebral body-thoracolumbar
BONY SPINE DEVELOPMENT
Normal neonatal spine-bone- within- bone
Fusion neurocentral synchondroses 3-6 yr.
Ring apophyses appear 6 years-fusion by 18yr
PLATYSPONDYLY
Flattening of body between intact end plates Vertebra plana-solitary platyspondyly
Histiocytosis X
Leukemia/lymphoma/mets
Tuberculosis
Hemangioma, GaucherÕs, Neurofibromatosis
C1-2 ARTICULATION
Occipitoatlantal- flexion/extension
Atlantoaxial- rotation
Subluxation-> 4-5mm. anterior arch C1 to dens C2
ODONTOID DYSPLASIA
Spectrum:
Aplasia
Hypoplasia
Detachment
C1-C2 SUBLUXATION
Pediatric Differential:
DownÕs
Morquio/ other MPS
Retropharyngeal abcess
Trauma
Collagen
Extensive splitting vertebral body
Anterior and posterior defects
T-spine
Association with neurenteric fistulas
CAUDAL REGRESSION
Sacral agenesis
type I- total or partial unilateral
type II- partial, bilateral symmetric, preserved sacroiliac articulation
SACRAL AGENESIS
type III- total sacral, variable lumbar, ilia
articulate with lowest vertebral body
type IV- iliac arthrosis or fusion
INFECTION PEDIATRIC SPINE
Osteomyelitis- Staphylococcus aureus, SC anemia salmonella. Progression to discitis
Endplate vascular territories
Sacroiliac pyarthrosis- uncommon, Staphylococcus aureus, may progress to ankylosis
DISCITIS(DISKITIS)
Spectrum- nonspecific, bacterial, viral
Primary or secondary spread from o.myelitis
6 months to 4 years, second
peak 10-14 years
PRIMARY TUMORS BONY SPINE
Almost any lesion occuring in any other bone
Painful scoliosis concave side spasm from the lesion
OSTEOID OSTEOMA
Age range 3-16 years, commonly 10-12 years at diagnosis
Posterior elements usually sclerosis pedicle
(differential- contralateral hypoplastic pedicle)
Osteoblastoma- >1 cm, large o. osteoma ANEURYSMAL BONE CYST
SACROCOCCYGEAL TERATOMA
1:35,000 incidence
All three germ cell layers represented
Female:male 4:1
Males- higher incidence of malignancy
SACROCOCCYGEAL TERATOMA
Older patient, increased malignancy rate
NO correlation increased malignancy rate with increased size
SACROCOCCYGEAL TERATOMA
Type I-external component
Type II- small intrapelvic component
Type III- small external component(large intrapelvic)
Type IV- Totally intrapelvic, presacral
SACROCOCCYGEAL TERATOMA
Immediate surgical extirpation
10% malignant at birth
91% contain malignant tissue at 2 months
Flexion injury- compressive force to bodies and distracting force to posterior elements
C1-2 base of dens, synchondrosis in infants Teardrop fracture
Clay shoveler C7 avulsion
PEDIATRIC SPINAL TRAUMA
Extension injuries: C1 arch fracture hangmans or C2 pedicle fracture
Axial loading: Jefferson C1 arch
Lumbar Chance fracture:
Distraction flexion injury
Total AP disruption of body and posterior elements
CHANCE FRACTURE
Motor vehicle accidents with seat belt restraint
Typically L1 or L2
Associated blunt visceral injuries
SPINAL TRAUMA BIRTH INJURY
Traction forces during delivery: upper cervical-cephalic, cervicothoracic- breech
Extradural hematoma to complete cord transection
Conventional imaging often normal
Type I- massive fusion many segments
Type II- most common C2-3 or C5-6 fusion
Type III- combination of I and II
Type II often asymptomatic
Sprengel deformity:
25% of Klippel-Feil have
40% with sprengel have K-F
High frequency GU anomalies
SCOLIOSIS
Idiopathic- resolving infantile l-thoracic <30deg, male
Idiopathic- progressive > 30deg 2 years increases 5 degrees/ year to major curve 200 degree
Idiopathic juvenile- girls 4-9 years d-thoracic
Adolescent idiopathic:
Females
15-20% family history
congenital heart disease 7% (15% cyanotic)
convex away from Ao arch
Congenital- anomalies spine/GU
Neuromuscular- C shaped
Lippman-Cobb
top maximal tilt
bottom widening disc space
KYPHOSIS
