Bone Disorders Of The Spine Flashcards
Grading scale of spondylolisthesis
Grade 1 = 0-25%
Grade 2 = 25-50%
Grade 3 = 50-75%
Grade 4 = 75-100%
Scheuermann’s disease usually has a kyphotic curve greater than _______ degrees
45
Grading for vertebral body compression fracture
Grade 0 = normal
Grade 1 = 20-25% height decrease
Grade 2 = 25-40% height decrease
Grade 3 = >40% height decrease
Treatment of scoliosis based on Cobb angles
<20º = observe
20-40º = brace
>40º and skeletally immature = surgery
>50 º and skeletally mature = surgery
When do you consider surgery for spondylolisthesis?
Symptomatic Grade 3, and Grades 4 and 5
What grade of spondylolisthesis do you restrict patient from contact sports
> Grade 2
Most common type/class of spondylolisthesis
Class II (Isthmic) which is due to par interarticularis fracture
An adolescent disorder of the vertebral endplates and apophysis resulting in increased thoracic kyphosis
Scheuermann’s disease
If there is pain walking downhilll, is that neurogenic or vascular claudication?
Neurogenic
If there is pain in the calf with riding a bike, is that vascular or neurogenic claudication?
Vascular
How many hours a day do you wear a brace for scoliosis, and how long do you wear it?
23 hours/day until skeletally mature and curves are stable
What is the Pavlov ratio?
AP diameter of canal : AP diameter of vertebral body
Nml = 1.0
Stenosis = <0.82
3 types of scoliosis
Idiopathic, congenital, neuromuscular
After a stable vertebral body burst fracture, how long do you brace for?
4-6 months
What type of brace do you use for a lower thoracic, thoracolumbar or lumbar curves?
Low profile TLSO
What do you see on imaging of the spine in scheuermann’s disease
Schmorl’s nodes
What is the diameter of spinal canal in central spinal stenosis?
< 10 - 12 mm
What type of brace do you use for a high thoracic curve?
Milwaukee brace (CTLSO)
When do you consider bracing vs surgery for scheuermann’s disease?
Bracing if kyphosis is <75º and surgery if >75º.
What is mechanism of injury that causes spondylolysis
Repetitive hyperextension forces
How much of vertebral translation is spondylolisthesis considered instability?
In C-spine = >3.5mm
In T- or L-spine = >5mm
What kind of exercises do you recommend for scheuermann’s disease
Thoracic extension and abdominal strengthening exercises
What are schmorl’s nodes
Herniation of disc material through the endplates
If there is a double major scoliotic curve, what is the usual pattern?
Right thoracic and left lumbar curve
In a thoracic curve, at what level is the apex usually at?
T7 or 8
If there is pain walking uphill, is that vascular or neurogenic claudication?
Vascular
What is the diameter of normal spinal cord? Diameter of normal spinal canal?
Spinal cord = 10mm
Spinal canal = 17mm
What kind of exercises do you prescribe for vertebral body compression fracture
Hyperextension exercises
If spondylolisthesis is congenital, what type/class is it?
Dysplastic (class I)
In lumbar scoliotic curves, what direction is the most common?
Left lumbar curves > right lumbar curves
How much of a decrease in vertebral height after a compression fracture do you recommend surgery?
50%
What vertebral level most commonly has spondylolysis?
L5
Most common type of scoliosis
Idiopathic
What type of exercises do you do for spondylolisthesis
Flexion-biased position exercises
What type of brace do you use for spondylolisthesis?
TLSO brace
Most common scoliotic curve pattern
Right thoracic curve
What kind of brace do you prescribe for vertebral body compression fractures?
TLSO/Jewett hyperextension brace
