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US has significant advan- – Limits repeat examination tages in accuracy over MRI 100mg viagra professional with visa, although both may be ¼ Films taken bending will show correctable (sec- required in borderline or complex cases [50–52] cheap viagra professional 100mg without a prescription. For ondary) curves open neural tube defects, closed myelomeningocele and cranial abnormalities MRI is the technique of choice. There are a number of disorders where the neural tube is intact but the bony architecture of the spine is abnormal. Children and adolescents who pres- ent with a lordoscoliosis or a kyphoscoliosis may be divided into those who have a congenital lesion (Fig. Some ado- lescents may show endplate abnormalities that were not present in infancy; these include Scheuermann’s disease and several skeletal dysplasias. To identify vertebral defects that might lead to progressive deformity 2. To identify neural tissue lesions that may damage the spinal cord function as the child matures 3. To follow the progress of the disease and judge response to treatment 5. Cheung ¼ “Cobb” angle measurement ¼ Young children may need to be sedated – Take the endplates of the vertebrae above ¼ Cannot be performed standing (except in very and below the lesion that show the maximum uncommon standing MR units) angulation; measure the angle between these two endplates US: – Be aware that minor rotation in subsequent films ¼ No ionizing radiation will lead to a different result ¼ Limited to soft tissue changes ¼ Spinal cord masked by the vertebral arch Back shape photographic methods More useful in infants (photogrammetry): ¼ Shows CSF pulsation ¼ No radiation and easy to perform ¼ Sedation not required – Use projected light to image the shape of the ¼ Effective in excluding cord tethering and neural back tube defects in infancy – Require the young person to undress ¼ Needs special equipment Myelography (with or without CT): – Often bespoke and difficult to replace ¼ An outdated technique replaced by MR ¼ Addresses the commonest complaint—cosmetic ¼ Rarely needed if MRI is contraindicated, e. The role – Chiari malformations (cerebellar tonsil of imaging is to exclude meningoceles, spinal cord herniation and fused vertebrae) tethering and large bony neural arch defects. Care – Syringomyelia should be taken not to alarm the parents and family – Thoracolumbar coronal T1 spin echo when there is an isolated bony arch defect as these Scoliosis are very common in the normal asymptomatic adult – Some vertebral anomalies especially population. In the newborn infant ossification of the hemivertebrae and butterfly vertebrae cartilage bony arch progresses from the region of the – Demonstrates kidneys (renal lesions are a pedicles and it is easy to look at the partial ossifica- common association with congenital spine tion margins and regard them as abnormal. The infant may be examined whilst held – Spinal cord tethering against the parent’s chest. A linear array high-reso- – Fused vertebrae lution probe is required and extended view imaging – Meningocele assists (Fig. The examiner should identify the – Lipoma of the cord conus medullaris which should have its tip at around – Cord tumours the first lumbar vertebra (Fig. The neural arch – Thoracolumbar axial T2* gradient echo (wide is best seen on axial images (Figs. Tethering will reduce – Split cord (may be missed on coronal and the movement and pull the conus lower down the sagittal images) canal. Their communication abnormal then MRI with the central canal will be demonstrable by pul- ¼ Scoliosis: plain film standing; if smooth curve then sation of CSF. MRI will be needed when ¼ MRI difficult to interpret: CT abnormalities are found and treatment is being con- ¼ MRI contraindicated: CT myelography sidered. It provides a better “road map” for the sur- ¼ Conservative treatment follow-up: photogramme- geon. Westhoff B, Wild A, Seller K, et al (2003) Magnetic reso- Potential Developments nance imaging after reduction for congenital dislocation of the hip.

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