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Neurosurgery Rounds > 6. Spine > Flashcards

6. Spine Flashcards

1
Q

of spinal nerves?

A

8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

Total 31

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2
Q

% people with low back pain sometime in life

A

80%

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3
Q

Definition of acute low back pain

A

<6w

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4
Q

Nonsurgical tx for spinal stenosis

A
  1. NSAIDS
  2. Analgesics (acetaminophen)
  3. Steroid injections (inflammation)
  4. Anesthetic nerve blocks
  5. Restricted activity
  6. PT
  7. Back brace
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5
Q

Radiculopathy

A

Irritation of LMN from mechanical/chemical insult to nerve root at single spinal level.
Burning pain/numbness with weakness/loss of reflex in corresponding nerve distribution

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6
Q

Polyradiculopathy

A

> 1 nerve root compression

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7
Q

Lasegue sign

A

Straight leg raise test (for disc herniation)

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8
Q

If cervical disk herniation at C4-C5, which nerve root will be affected?

A

C5

lower nerve root

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9
Q

Spurling test

A

Increased pain along nerve distribution from cervical extension with axial compression/rotation of head (decrease size of neural foramen)

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10
Q

Cervical myelopathy

A

LMN symptoms in upper extremity (loss of manual dexterity/muscular atrophy), from chronic pressure on cervical spinal cord from degenerative process.
+ neck pain, stiffness, clonus, hoffman/babinski signs

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11
Q

Red flags in spinal eval

A

Fever, pain in recumbent position, weight loss, B&B dysfunction, trauma, hx cancer, saddle anesthesia, failure to respond to tx

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12
Q

Schober test

A

Measures movement of lumbar spine

10cm proximal and 5cm distal to line between posterior superior iliac spine in midline - at least >5cm in extension

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13
Q

Malnourished patient with symmetric paresthesias in feet/hand and poor proprioception

A

B12

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14
Q

Knee reflex

A

L4

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15
Q

Achilles reflex

A

S1

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16
Q

Lateral recess stenosis, SLR negative or positive?

A

Negative

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17
Q

GBS and SLR?

A

SLR often positive in GBS

back pain, radiculopathic symptoms + SLR, and hx of viral event

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18
Q

Patrick test for lower extremities (FABER test for flexion, abduction, and external rotation)

A

Arthritis of hip
1. figure 4 of hip
2. pressure on tested knee
look for pain (anterior hip capsule)

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19
Q

SLR nerve root

A

L5 and S1

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20
Q

Types of nerves in dorsal ramus of nerve root

A

Dorsal portion of trunk carrying visceral motor, somatic motor and sensory to/from skin and back muscles

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21
Q

Types of nerves in ventral ramus of nerve root

A

Visceral motor, somatic motor and sensory to/from ventrolateral body surface, body wall and limbs

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22
Q

Lateral recess stenosis and herniated lumbar disk pain with sitting

A

LRS: relieved by sitting
HLD: exacerbated by sitting

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23
Q

Why C5 radiculopathy can follow anterior/posterior decompression even after no obvious complication

A

C5 radiculopathy (deltoid weakness) from traction of nerve root from posterior migration of cord (shortest length from foramen to muscle ending)

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24
Q

Paget disease: urinary metabolite

A

hydroxyproline

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25
Spinal tract for lower limb subconscious proprioception
Spinocerebellar
26
Intercristal line on AP and lateral x-ray
Confirms location of L5 and L4-L5 disk
27
L'Hermitte phenomenon
Electric sensation running down back | MS, cervical myelopathy, subacute combined degeneration
28
Compressive lesion of craniocervical border - nystagmus?
Downbeat
29
Cape-like sensory deficit
Central cord lesion damaging second seonsory neuron crossing to join lateral spinothalamic tract
30
How can C5-C6 disk cause C7 symptoms
Prefixed brachial plexus - normal levels of innervation abberrant by 1 level
31
Mechanical vs ankylosing spondylitis back pain
Relieved by rest vs morning/noctural pain
32
Why are disk herniations usually posterolateral?
Posterior longitudinal ligament in the center prevents herniating posteriorly directly
33
What makes up the annulus fibrosis?
Fibrocartilage
34
Most common extraarticular manifestation of ankylosing spondylitis
Acute anterior uveitis
35
Types of spondylolisthesis?
Spondylolisthesis: forward displacement of vertebra | Congenital, ischemic, degenerative, traumatic, pathologic, iatrogenic/post-surgical
36
What spondylolisthesis is thought to result from stress fracture of pars interarticularis?
isthmic spondylolisthesis
37
Main causes of thoracic myelopathy from degenerative dx
Herniated disks, ossification of posterior longitudinal ligament/flavum, posterior bone spurs
38
What MSK conditions can mimic lumbar spine problems?
Hip osteoarthritis - check hip internal rotation Vascular insufficiency/claudication (peripheral vasc. exam) Piriformis syndrome/inflammatory sacroillitis (mimic S1) with buttock pains/radicular pain in S1
39
How long must elective surgery wait for patient taking clopidogrel?
7-10 days
40
Lab test to test coagulation for patient on clopidogrel
Bleeding time (PT/PTT/INR may be normal)
41
Cervical level of inferior edge of mandible
C2
42
Cervical level of hyoid bone
C3
43
Cervical level of thyroid cartilage
C4-5
44
Cervical level of cricoid ring
C6
45
Largest/strongest cervical vertebra
C2
46
Which vertebra has no body
C1
47
Cervicothoracic inflection point (point where cervical lordosis becomes thoracic kyphosis)
T3
48
Best way to verify T7 when patient is prone
line between scapula tip to another
49
Normal ROM of cervical spine
Flexion 45 Extension 55 Lateral 40 Rotation 70
50
Sensory/motor distribution and reflex of C5
S: lateral arm M: deltoid R: none
51
Sensory/motor distribution and reflex of C6
S: lateral forearm M: wrist extension, biceps R: brachioradialis
52
Sensory/motor distribution and reflex of C7
S: middle finger M: tricep, wrist flex, finger extension R: triceps
53
Sensory/motor distribution and reflex of C8
S: small finger M: finger flexion R: none
54
Sensory/motor distribution and reflex of T1
S: medial arm M: interossei R: none
55
Which nerves arise from lateral cord?
lateral pectoral nerve (pectoralis major) | musculocutaneous (biceps)
56
Which nerves arise from posterior cord?
Upper subscapular nerve (C7/8) to subscapularis Lower subscapular nerve (C5/6) to teres major Thoracodorsal nerve (C6-8) to lat dorsi Axillary nerve (deltoid) Radial nerve (Tricheps, brachioradiali, finger/wrist extensors)
57
Motor/sensory distribution of L1
Sensation of anterior thigh | Innervation of psoas muscle
58
Motor/sensory distribution of L2
Sensation of anterior thigh/groin | Innervation of quadriceps
59
Motor/sensory distribution of L3
Sensation of anterior/lateral thigh | Innervation of quadriceps muscle
60
Motor/sensory distribution of L4
Sensation of medial leg/foot | Innervation of tib ant
61
Motor/sensory distribution of L5
Sensation of lateral leg/dorsal foot | Innervation of ex hal long
62
Motor/sensory distribution of S1
Sensation of lateral and plantar foot | Innervation of gastroc and peronealis
63
Dissection of psoas muscle should take into account which nerve on anterior surface of the muscle?
Genitofemoral
64
Where/how does disk herniation cause radiculopathy?
Posterolateral disk herniation: compress traversing nerve root Lateral herniation: compress exiting nerve root Large central herniation: single/multiple caudal nerve roots (caudal equina)
65
Posterolateral vs lateral L4-L5 disk herniation affects what roots?
Posterolateral: L5 Lateral: L4
66
Superficial abdominal reflex
Stroking each four quadrants of abdomen - mvm of umbilicus toward stroked segment (nml - UMN reflex) Asymmetry suggests intraspinal pathology (thoracic MRI)
67
Anatomic landmark to verify location of lumbar pedicle
Crest of transverse process
68
Which ligament serves as ventral extent of safe dissection to avoid injury to spinal nerve root during exposure/decortication of transverse process?
Intertransverse ligament
69
The first vertebra that can safely accomodate a pedicle screw?
C7 (no vertebral artery)
70
Sympathetic plexus lies ventral to what joint?
Costovertebral joint
71
Sympathetic outflow arises from what nucleus of the cord and what spinal cord levels?
Intermediolateral nucleus of T1-L2
72
Best place near nerve root to expose intervertebral herniated disk
Shoulder of nerve root
73
Indications for surgery in lumbar spine?
Emergent: cauda equina/progressive motor deficit Elective: incapacitating leg pain, nerve root tension signs, failure to respond to conservative tx
74
Indications for cervical spine surgery?
Significant radicular pain, progressive neurologic deficity, myelopathy or radiculopathy
75
Surgical intervention for spinal infection
``` Open biopsy (if closed failed) Drainage of abscess Decompression of cord/nerve root with neurologic deficit ```
76
Surgical indication for primary spine tumor
Open biopsy Failure of chemo/radiation Decompression of cord/root for neurologic deficit
77
Surgical indication for metastatic spine tumor
Open biopsy Failure of chemo/rad Decompression Intractable pain despite steroids
78
Indication for adult spine scoliosis
Progressive deformity, intractable pain, cardiopulm symptoms
79
Name for dorsal ramus of C1 nerve root
Suboccipital nerve
80
Anterior cervical diskectomy
1. Plastysma (first muscle) 2. Palpate carotid - displace laterally 3. Identify esophagus - displace medially 4. Anterior spine
81
Which groove is the recurrent laryngeal nerve located?
Tracheoesophageal groove
82
Which side of neck does laryngeal nerve have more variable course?
Right side - increased risk of injury
83
Complications from anterior cervical diskectomy/fusion?
Postop dysphagia, hematoma, recurrent laryngeal nerve palsy, esophageal perforation, Horner
84
How can patient develop horner syndrome after anterior cervical diskectomy?
Disruption of sympathetic plexus - dissection too lateral on longus colli muscle
85
Occipitocervical fusion - where is it safe to drill a hole and place a screw in the occiput?
Halfway between foramen magnum/transverse sinus, 3cm off midline
86
Drugs that inhibit bony fusion
Steroids, NSAIDS, immunosuppresants, nitocine
87
Somatosensory evoked potential?
Direct feedback on integrity of posterior columns by stimulating posterior tibial nerve and recording response of somatosensory cortex (spinal cord function, but not motor)
88
Transcranial motor evoked potential
Stimulate scalp over motor cortex - integrity of corticospinal tract
89
Pedicle screw stimulation
Integrity of pedicle. Bone is insulator - intact pedicle require threshold of 8 mA to activate nerve
90
Bone morphogenetic protein
Bone growth factor to promote bone formation
91
How is far lateral disk herniation identified; most common location?
Lateral to line drawn between 2 adjacent pedicles - most common is L4-L5
92
Best place to insert intrathecal baclofen pump
T10-T12 - spastic diplegia C5-T2 - spastic tetraplegia C1-C4 - generalized secondary dystonia

Neurosurgery Rounds (10 decks)

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