🦴 Chapter 720 · The Spine

Nelson Textbook of Pediatrics 22nd Edition | Scoliosis: idiopathic (adolescent, juvenile, infantile), congenital, neuromuscular. Bracing (Boston brace, 18h/day) for curves 25-45°. Surgery (fusion) for >45-50°. Kyphosis: Scheuermann disease (structural, >5° wedging of ≥3 vertebrae). Spondylolysis/spondylolisthesis: pars defect, L5 most common, worse with extension. Spine infection: discitis/osteomyelitis, S. aureus, MRI diagnosis. Disc herniation: rare in children. Tumors: osteoid osteoma (night pain, relieved by NSAIDs), eosinophilic granuloma (vertebra plana).

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📋 30 Clinical Scenarios — Spine Disorders

📇 High‑Yield Review Cards

🩺 Clinical Recognition: Spinal Disorders

Select a presentation to review diagnostic clues and management per Nelson Ch 720.

📋 Stepwise Management of Spinal Disorders

🔑 Key Principles — Nelson Chapter 720
• Adolescent Idiopathic Scoliosis (AIS): Cobb angle 10-25° → observe. 25-45° → brace (Boston, 18h/day). >45-50° → surgery (posterior spinal fusion).
• Early-onset scoliosis: Mehta casting, growing rods (VEPTR, MCGR).
• Scheuermann kyphosis: Bracing if >55-60° and growth remaining. Surgery if >70-80° with pain/cosmesis.
• Spondylolysis: Rest, PT, bracing. Spondylolisthesis: low-grade → conservative; high-grade → surgery.
• Discitis/osteomyelitis: MRI, IV antibiotics (S. aureus coverage).
• Osteoid osteoma: Night pain relieved by NSAIDs. Radiofrequency ablation.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: The Spine (Nelson 720)