Goldstien List spine

Question 1

Risk factors for surgical site infection in spine surgery (13)

Answer 1

• Age > 60
• Smoking
• Diabetes
• Obesity
• EtOH abuse
• Steroid use
• Trauma patients
• Previous surgical infection
• Previous spinal surgery
• Pre-op hospitalization > 1 week
• Surgery > 5 hours (#1)
• Blood loss > 1 litre
• Posterior spinal surgery

Question 2

Biochemical changes in aging discs

Answer 2

• Decreased water
• Decreased proteoglycan
• Decreased chondroitin sulfate
• Increased collagen
• Increased keratin sulfate

Question 3

Anterior cervical spine landmarks (6)

Answer 3

• Angle of the mandible C1/2
• Hyoid bone C3
• Superior thyroid cartilage C4/5
• Inferior thyroid cartilage C5/6
• Cricoid cartilage C6
• Carotid tubercle C6

Question 4

Complications of anterior cervical spine surgery (8)

Answer 4

• Neurologic injury
• Pseudarthrosis
• Airway compromise
• Recurrent laryngeal nerve injury (dysphonia)
• Dysphagia
• Esophageal injury
• Graft dislodgement
• Stroke (carotid artery compression)

Question 5

Risk factors for airway complications in cervical spine surgery (3)

Answer 5

• Surgical time > 5 hours
• Blood loss > 300 mL
• Multilevel surgery at/above C3/4

Question 6

Risk factors for prolonged dysphagia after anterior cervical spine surgery (3)

Answer 6

• Female
• Revision surgery
• Multilevel surgery

Question 7

Clinical syndromes associated with cervical spondylosis (4)

Answer 7

• Myelopathy
• Axial neck pain
• Radiculopathy
• Combination
• (M.A.R.C.)

Question 8

XR findings of cervical spondylosis (5)

Answer 8

• Facet hypertrophy
• Loss of disc height
• Loss of cervical lordosis
• Osteophytes
• Subchondral sclerosis/cysts
• (F.L.L.O.S.)

Question 9

MRI findings of cervical spondylosis (5)

Answer 9

• Soft disc herniations
• Foraminal stenosis (uncovertebral joint spurs)
• Decreased SAC
• Myelomalacia
• Ligamentum flavum hypertrophy
• (Front → back)

Question 10

Surgical options for cervical spondylosis (5)

Answer 10

• Anterior cervical discectomy and fusion
• Cervical disc arthroplasty
• Posterior keyhole laminoforaminotomy
• Laminoplasty
• Posterior cervical laminectomy and fusion
• (Front → back)

Question 11

Indications for surgical intervention in cervical spondylosis (5)

Answer 11

• Myelopathy
• Radiculopathy unresponsive to treatment
• SAC ≤ 13 mm with myelomalacia in an asymptomatic patient
• Intractable neck pain with1 or 2 level disease

Question 12

Indications for cervical laminoplasty (3)

Answer 12

• Preserved cervical lordosis
• Multilevel anterior compression
• Ossification of the posterior longitudinal ligament)

Question 13

Complications of cervical laminoplasty (3)

Answer 13

• Decreased range of motion
• Axial neck pain
• Kyphosis

Question 14

Causes of cervical Myelopathy

Answer 14

• Congenital stenosis
• Ossification of the posterior longitudinal ligament
• Acquired stenosis (spondylosis, tumor, infection)
• Loss of cervical lordosis
• (C.O.A.L.)

Question 15

Clinical findings of cervical Myelopathy (6)

Answer 15

• Upper extremity clumsiness
• Myelopathy hand
• Sensory abnormalities
• Upper motor neuron findings
• Bowel/bladder dysfunction
• Gait abnormalities (broad-based gait)
• (Upper → lower)

Question 16

Ranawat classification of cervical myelopathy (4)

Answer 16

• Class I: pain, no neurologic deficit
• Class II: subjective weakness, hyperreflexia, dysesthesias
• Class IIIA: objective weakness, long tract signs, ambulatory
• Class IIIB: objective weakness, long tract signs, nonambulatory

Question 17

Nurick myelopathy scale (5)

Answer 17

• Grade 0: nerve root signs, no cord involvement
• Grade I: nerve root signs, cord involvement, normal gait
• Grade II: nerve root signs, cord involvement, mild gait abnormality
• Grade III: nerve root signs, cord involvement, severe gait abnormality
• Grade IV: nerve root signs, cord involvement, gait only with assistance

Question 18

Imaging findings of cervical myelopathy (4)

Answer 18

• Sagittal canal diameter ≤ 13 mm
• Pavlov’s (Torg’s) ratio < 0.8 (canal:vertebral body width)
• Cord flattening on MRI
• Myelomalacia (↓ signal on T1 and ↑ signal on T2)

Question 19

Types of clinical course of cervical myelopathy (Clark & Robinson) (3)

Answer 19

• Stable (75%)
• Slow, steady decline (20%)
• Rapid decline (5%)

Question 20

Factors in decision-making process for surgical treatment of cervical myelopathy (4)

Answer 20

• Location of compression
• Alignment of the spine
• Number of involved levels
• Nature of compression (soft tissue vs. bone)

Question 21

Indications for cervical disc arthroplasty (5)

Answer 21

• Patient < 65 years of age
• MRI findings consistent with disc degeneration or herniation
• Radiculopathy or myelopathy
• Involvement of 1-3 segments
• Failure of 6 weeks of nonoperative management

Question 22

Contraindications to cervical disc arthroplasty (10)

Answer 22

• • AS, RA, OPLL, DISH
• • IDDM
• • Osteoporosis
• • Obesity
• • Pregnancy
• • Neck Pain without Objective Evidence
• • Cervical Instability
• • Previous ALIF
• • Previous INFECTION
• Previous FRACTURE

Question 23

Risk factors for cervical spine involvement in rheumatoid arthritis (5)

Answer 23

• Mutilating arthritis
• Males
• Longer duration of disease
• Seropositive disease
• Steroid treatment
• (M.M.L.S.)

Question 24

Patterns of rheumatoid arthritis involvement in the cervical spine (4)

Answer 24

• Atlantoaxial instability (#1 - 50-80%)
• Basilar invagination (#2 - 40%)
• Subaxial instability (20%)
• Combination (#3)

Question 25

Indications for surgical intervention in rheumatoid atlantoaxial instability (6)

Answer 25

Absolute (3)

• SAC ≤ 13 mm on flexion XR
• Cord < 6 mm on flexion MRI
• Ranawat IIIA/B myelopathy

Relative (3)

• Progressive instability
• Intractable pain
• AADI ≥ 10 mm on flexion XR

Question 26

Methods of posterior C1-2 fixation (3)

Answer 26

• Posterior wiring techniques (Brooks, Gallie)
• Transarticular screws (Magerl)
• Posterior screw/rod fixation (Harms technique – C1 lateral mass, C2 pedicle)