Degenerative Flashcards
Relative cervical stenosis measures:
10-13mm canal
Absolute cervical stenosis measures
10mm canal or less
Bad Torg ratio is:
<0.8
not considered an absolute contraindication to return to play
Risk of having cervical MRI changes if >age 40 years?
57% (Boden study)
Return to work rates following an episode of low back pain:
60-70% by 6 weeks
80-90% by 12 weeks
How many Waddell signs needed for positivity of test?
3 is suggestive of inorganic cause of back pain
Specfic radiographic findings of tuberculous spondylitis?
vertebral body involvement with sparing of the disc space - differentiates from pyogenic infections
- abscesses typically appear anterior vertebral body
how long can mycobacteria take to grow in culture
10 weeks
Meds for spinal TB:
isoniazid
rifampin
ethambutol
pyrazamide
In chldren with kyphosis from spinal TB, what are rates of progression?
even after cure, progression rates are 40% without reconstruction
Spinal manifestations of Langerhans cell histiocytosis
vertebra plana
most common location of spinal TB in children?
anterior vertebral body in the lower thoracic region
what is the histologic stain for tB:
Ziehl-Neelsen
in CSSM, what is rate of tandem lumbar stenosis
20%
Ranawat classification of CSM:
1: normal examination, complaining of pain
2: subjective weakness, hyperreflexia, dyssesthesias
3A: objective weakness, long tract signs, ambulatory
3B: objective weakness, long tract signs, non-ambulatory
lower limit of compression ratio
0.4
below this indicates poor prognosis for recovery in CSM
advantages of anterior approach to posterior approach in CSM surgery:
- less blood loss
- lower infection rate
- less post operative pain
Rates of post-operative C5 palsy after anterior OR posterior decompression on C spine:
5%
can you do laminoplasty in setting of OPLL?
yes
a two level cervical corpectomy also needs:
posterior decompression and fusion due to high rates of graft migration
known risk factors for airway complications following ACDF:
- surgical time >5 hours
- mutilevel surgery at or above C3-4
- blood loss >300
consider maintaining intubation for 24-48 hours
TLICS score indicating surgery:
> 4
if =4 then could go either way
Important points for the TLICS scoring system:
morphology
neurologic status
integrity of the PLC
Burst = 2 points nerve root injury = 2 points incomplete cord = 3 points complete cord = 4 points PLC out = 3 points (interspinous distance increased)
how many levels do you isntrument when treating TL burst fractures?
historically 3 above, 2 below
modern pedicle screw constructs suggest 1 above and 1 below
Rates of LFCN paresthesia following
24%
- risk with surgery longer than 3.5 hours
4 year SPORT outcomes for degen spondy?
- with surgery, improved pain and function scores relative to those treated non-operatively
what would increase the rate of adjacent segment disease following single level lumbar decompression and fusion
adjacent level laminectomy (especially above)
rate of adjacent segment disease after lumbar fusion?
2.5% per year
risk factors for nonuinon following spinal fusion:
- smoking
- multilevel fusion
- malnutrition
- sagittal imbalance
- prior spine surgery
- oral anti-infalmmatory use
risk factors for in hospital complication following lumbar fusion include:
- age
- having 3 or more medical co-morbidities
what pelvic measure correlates with degree of isthmic spondy?
pelvic incidence
- higher is a risk factor
most common nerve root injured after reduction of an isthmic L5-1 slip?
L5
incidence of spondylolysis in North America?
4% of Americans by age 6 will have a pars defect
up to 6% for patients aged 12-25 years
where is a pars defect most likely to occur?
90% occur at L5-S1
Diagnosis of DISH made by:
non-marginal syndesmophytes at 4 contiguous vertebrae (3 levels)
Risk factors for DISH:
- DIABETES
- gout
- hyperlipidemia
where should you get xrays tobe most likely to find DISH?
T7-T11
differentiating AS from DISH?
AS will show obliteration of disk spaces AS will show marginal syndesmophytes AS with osteopenia AS with HLA-B27 association AS with bilateral sacroiliitis AS not associated with diabetes
