24. Define type of torticollis?

Torticollis is a clinical diagnosis based on head tilt in association with a rotatory deviation of the
cranium. Congenital muscular torticollis is the most common type of torticollis. It presents in the
newborn period. Its cause is unknown, but it has been hypothesized to arise from compression of
the soft tissues of the neck during delivery, resulting in a compartment syndrome. Radiographs of
the cervical spine should be obtained to rule out congenital vertebral anomalies. Clinical
examination reveals spasm of the sternocleidomastoid muscle on the same side as the tilt
causing the typical posture of head tilt toward the tightened muscle and chin rotation to the
opposite side. Initial treatment is stretching and is successful in up to 90% of patients during the
first year of life. Surgery is considered for persistent deformity after 1 year of age. Common
problems noted in patients with congenital muscular torticollis include congenital hip dysplasia
and plagiocephaly (facial asymmetry).
Source: Spine Secret Plus, 2nd ed. page 256.
25. What clinical problems result from basilar impression?
Patients present with a short neck, painful cervical motion, and asymmetric of the skull and face.
Additional clinical problems include nuchal pain, vertigo, long tract signs with associated
cerebellar ataxia, and lower cranial nerve involvement resulting in dysarthria and dysphagia
Source: Spine Secret Plus, 2nd ed. page 258
26. What is Steels Rule of Third?
Steel noted that the area of the spinal canal at the C1 leve in a normal person could be divided
into equal thirds with one third occupied by the odontoid process, one third by the spinal cord,
and one third as empty space. The empty space serves as a safe zone into which displacement
can occur without neurologic impingement. In the presence of atlantoaxial instability, the safe
zone may decrease resulting in spinal cord compression.
Source: Spine Secret Plus, 2nd ed. page 258
27. Describe the typical presentation of a patient with thoracic Scheuermanns disease?
A male or female approaching the end of skeletal growth (1215 years old) presents with
complaints of thoracic deformity and/or back pain. The patient has an increased thoracic
kyphosis, which is accentuated with forward-bending. Patients are not able to correct the
kyphotic deformity by active extension. Thirty percent of patients have mild scoliosis in addition
to increased kyphosis. A compensatory increase in cervical lordosis causes the head to translate
forward. Patients often have tight hamstrings.
Source: Spine Secret Plus, 2nd ed. page 279

28. What are the accepted radiographic criteria for diagnosis of thoracic Scheuermanns
disease?
The commonly accepted criteria--5 of wedging of three adjacent vertebrae--were popularized by
Sorenson. Thoracic kyphosis greater than 50, vertebral endplate irregularities, Schmorls nodes,
and decreased disc space height are additional radiographic findings that may be present.
Scheuermanns kyphosis is structural and does not correct to within normal limits with maximal
extension.
Source: Spine Secret Plus, 2nd ed. page 279
29. What are the indication for orthotic treatment for Scheuermanns kyphosis?
Extension bracing is appropriate for curves between 45 and 74 with 2 years of growth
remaining and greater than 5 wedging. An apex at T9 or above it traditionally treated with a
Milwaukee type brace. A thoracolumbar orthosis (TLSO) is considered if the apex is below T9.
Braces should be updated every 4 to 6 months to maximize deformity correction and weaned
with skeletal maturity.
Source: Spine Secret Plus, 2nd ed. page 280
30. What is the cause of congenital scoliosis?
A lateral curvature of the spine is caused by vertebral anomalies that produce a frontal plane
growth asymmetry. Homeobox genes of the Hox class are thought to be responsible for the
congenital spinal malformations.
Source: Spine Secret Plus, 2nd ed. page 291.