Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes...
-
Upload
jonas-sanderford -
Category
Documents
-
view
216 -
download
2
Transcript of Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes...
![Page 1: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/1.jpg)
Neonatal SpineTanya Nolan
![Page 2: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/2.jpg)
Embryology Ectoderm
Neural tube arises from ectodermal cells and becomes the spinal cord and brain.
Mesoderm Forms bony spine,
meninges, and muscle
![Page 3: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/3.jpg)
Embryology Defects of the spine occur in the first 8.5 wks of
life as the fetal nervous system develops Incomplete seperation of the neural tube from the
ectoderm Cord tethering, Diastematomyelia, or a Dermal sinus
Premature Seperation Lipomas
Failure of neural tube to fold and fuse in the midline Myelomeningocele
Disorders of distal cord Fibrolipomas of the filum terminale
![Page 4: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/4.jpg)
Anatomy Vertebral Column
Houses spinal cord, spinal nerve roots, and meninges
Total 33 Vertebrae 7 Cervical 12 Thoracic 5 Lumbar 5 Sacral 4 Coccygeal
![Page 5: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/5.jpg)
Spinal Cord Cylindrical, grayish
white structure Meninges
Dura Mater Outer strong, dense,
fibrous sheet Arachnoid Mater
Middle layer Subarachnoid
Space: Filled with cerebral spinal fluid.
Pia Mater Inner vascular layer
![Page 6: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/6.jpg)
Spinal Cord Begins
Above the formamen magnum and is continuous with the medulla oblongata
Terminates Adult: Lower border of L1 Child: Upper border of L3
![Page 7: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/7.jpg)
Spinal Cord Conis Medularis
Inferiorly cord tapers to a point
Filum Terminale Prolongation of pia
matter that is attached to the coccyx
Cauda Equina “Horse tail” Lower nerve roots
![Page 8: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/8.jpg)
Nerve Roots 31 Pair Carries impuses to and from the brain to the rest of the body.
![Page 9: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/9.jpg)
Indications for Sonographic Examination Midline Cutaneous Abnormality Sacral Dimple
Deep Asymmetric Suspicious if more than 1 inch from anus
Hemangioma Raised midline Hairy Patch Tail-like projection of lower spine Diagnosis of myelomeningocele or myeloschisis Lower extremity deformity
![Page 10: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/10.jpg)
Sonographic Technique Patient Position
Prone Spine flexed (seperates
posterior elements) Lateral Decubitus Upright
Transducer High frequency linear array Possible stand off pad
![Page 11: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/11.jpg)
Sonographic Technique Where do you begin?
1) Sacral area & count stepwise ascent of sacral vertebral elements
2) Count from lowest rib bearing vertebra (rib over kidney & follow medially)
Determine level of Conus Medullaris!!!
![Page 12: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/12.jpg)
Sonographic Appearance Vertebral Bodies
Echogenic; anterior Lamina
Slighly off midline; “Overlapping Roof Tiles” Spinous Processes
Inverted “U”s Coccyx
Hypoechoic, do not mistake for a fluid collection. Spinal Cord
Hypoechoic with slightly echogenic borders and an echogenic line extending along its middle.
Nerve Roots Echogenic Move and change configuration during respiratory variations.
Conus Medullaris Normally above endplate of L3; Most cords end above L2. (Most tethered cords
are unquestionably low.)
![Page 13: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/13.jpg)
Sonographic AppearanceSagittal View
Anterior echogenic body surface; posterior dorsal spinal elements. 1. Posterior elements or spinous processes 2. posterior arachnoid-dural layer bordering spinal canal 3. subarachnoid space filled with cerebrospinal fluid 4 posterior margin of the spinal cord 5. spinal cord with central echo complex 6. Anterior margin of the spinal cord
![Page 14: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/14.jpg)
Sonographic AppearanceLevel of the Conus – Sagittal View
Tapered conus medullaris shows the end of the spinal cord. 1. Posterior elements or spinous processes 2. cauda medullaris 3. filum terminale 4. cauda equina and nerve roots.
![Page 15: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/15.jpg)
Sonographic AppearanceLevel of the Conus – Transverse View
Nerve roots are echogenic as they surround the spinal cord. 1. Paravertebral muscles 2. Laminae of vertebral arches 3. subarachnoid space filled with cerebrospinal fluid 4. spinal cord with central echo complex 5. paired dorsal and ventral nerve roots 6. vertebral body.
![Page 16: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/16.jpg)
Pathology
![Page 17: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/17.jpg)
Tethered Cord Fixation of cord @
caudal location (below L3)
Diminished cord movement.
Cord mechanical stretching, distortion, and ischemia with growth and activity.
TC
L
![Page 18: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/18.jpg)
Tethered Cord
Sonographic Findings Visualization of
cord caudal to normal termination
Diminished cord pulsation
Eccentric cord location with the canal
Intradural lipoma and tethered cord in 2-week-old girl with hairy patch on lower back. Longitudinal sonogram reveals typical features of hyperechoic lipoma (calipers) attached to dorsal aspect of thoracolumbar spinal cord. Conus is tethered to mass at L3-L4 disk space.
![Page 19: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/19.jpg)
Lipoma Mass of filum terminale Continuous with
subcutaneous tissues & presents as a fatty back lump.
Frequently associated with tethered cord.
Sonographic Finding Echogenic Mass
![Page 20: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/20.jpg)
Hydromelia Dilation of central canal
Diffuse or focal Associated with
myelomeningocele and diastemotomyelia May mimic or co-exist
with syringomyelia Sonographic Findings
Separation of echogenic linear structures of central canal.
Hydromyelia in a 1-month-old infant in whom lumbar myelomeningocele and thoracic hydromyelia were noted on the 1st day of life. Sagittal US scan shows a dilated central canal (arrows).
![Page 21: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/21.jpg)
Diastamatomyelia
Cord is split at one or more sites by a septum
Assoiated with meningocele or myelomeningocele
Vertebral column abnormal on plain radiography
Sonographic Findings
Split segments best seen in transverse views
Transverse scan of the lumbar spinal canal shows left and right hemicords. Each hemicord has an eccentric central canal
![Page 22: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/22.jpg)
Cysts on Spinal Cord May be seen in
cauda equine or filum terminale Small cysts in filum
terminale may be remnants of a terminal ventricle or an arachnoid pseudocyst
Related to Tethered Cord
![Page 23: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/23.jpg)
MyelomeningoceleSpina Bifida
Low termination of spinal cord
Protruding pouch containing CSF and nerves
Sonographic Findings Pre-op exams can
differentiate between myelomeningocele and meningocele
Flat nontubulated cord with nerve roots extending into the defect.
![Page 24: Neonatal Spine Tanya Nolan. Embryology Ectoderm Neural tube arises from ectodermal cells and becomes the spinal cord and brain. Mesoderm Forms bony spine,](https://reader036.fdocuments.in/reader036/viewer/2022062515/56649c775503460f9492cb0f/html5/thumbnails/24.jpg)
Dermal Sinus Tract Small dimple-like opening in the
midline of the spine connecting deep into the spinal cord.
The majority located at the level of the sacrum or the lumbar region.
Communication with spinal canal contents increases possibility of meningitis
Attaches to the end of the spinal cord, causing tethering.
Sonographic Findings Easily followed if fluid filled or
disrupts normal soft tissue planes Dural penetration is difficut to
ascertain or exclude on sonography