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INTRODUCTION

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Orthopedic problems are common in neonates. The problems can be isolated deformities or part of a generalized disorder. Usually these deformities are obvious, but a comprehensive musculoskeletal examination is the key for diagnosis of associated generalized disorders. This chapter provides an overview of the common problems encountered in the neonatal intensive care unit. Many images of these neonatal orthopedic and musculoskeletal conditions, designated by Image not available., can be found online by visiting www.neonatologybook.com and clicking on the image tab.

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I. SPINE PROBLEMS

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  1. Scoliosis

    1. Definition. Scoliosis is a lateral deviation of the spine that is >10 degrees and typically includes the rotation and sagittal deformity. Scoliosis is classified into several types including idiopathic, congenital, and neuromuscular.

      1. Infantile idiopathic scoliosis is more common in boys and in Europe than North America. It is an uncommon scoliosis and thought to be related to infant positioning. Most children are diagnosed within the first 6 months of life and have left-sided thoracic curves. Plagiocephaly is a common association. The natural history is controversial, but these curves can improve spontaneously. Radiographic measures described by Mehta have been used to predict the likelihood of progression. Neuro-axis abnormalities have been noted in over 20% of these children, and a magnetic resonance image (MRI) of the spine is recommended for children with curves measuring 20 degrees or more. Casting and bracing have been successful treatment modalities in this condition. Occasionally surgical treatment is required, and the instrumentation is typically a growing rod.

      2. Congenital scoliosis is caused by anomalies in the growing vertebra. The etiology is unknown, but studies have indicated that carbon monoxide exposure may be a factor, and recent genetic studies suggest a possible congenital basis.

        The neuro-axis, vertebral column, and organ systems develop at similar periods in utero. Neuro-axis abnormalities can occur in up to a third of these children, 20% will have a genitourinary abnormality, and 20% will have a cardiac abnormality. The classification consists of 2 basic abnormalities: defects of vertebral formation and defects of vertebral segmentation. The hemivertebrae is an example of a defect in formation, while defects of segmentation include block vertebra and unilateral bars (this is where 1 side of 2 vertebrae are connected, leading to a growth tether).

        Progression of the deformity is typically due to unbalanced growth and can be highly variable. A hemivertebrae with normal growth caudally and cranially can progress significantly. The unilateral bar is the most common cause of congenital scoliosis and can result in significant deformity, particularly if there are hemivertebrae associated.

    2. Treatment. Bracing is usually not a successful treatment regimen. Surgical management may be indicated for progressive curves. It may consist of vertebral resection and spine realignment or fusion to prevent further progression.

  2. Spina bifida Image not available.

    1. Definition. This group of disorders is characterized by congenital malformation of the spinal cord and vertebral column. Whereas the etiology of spina bifida is unknown, inadequate maternal intake of folic acid, gestational diabetes, and history ...

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