Goldstien List spine Flashcards
Risk factors for surgical site infection in spine surgery (13)
- 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
Biochemical changes in aging discs
- Decreased water
- Decreased proteoglycan
- Decreased chondroitin sulfate
- Increased collagen
- Increased keratin sulfate
Anterior cervical spine landmarks (6)
- 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
Complications of anterior cervical spine surgery (8)
- Neurologic injury
- Pseudarthrosis
- Airway compromise
- Recurrent laryngeal nerve injury (dysphonia)
- Dysphagia
- Esophageal injury
- Graft dislodgement
- Stroke (carotid artery compression)
Risk factors for airway complications in cervical spine surgery (3)
- Surgical time > 5 hours
- Blood loss > 300 mL
- Multilevel surgery at/above C3/4
Risk factors for prolonged dysphagia after anterior cervical spine surgery (3)
- Female
- Revision surgery
- Multilevel surgery
Clinical syndromes associated with cervical spondylosis (4)
- Myelopathy
- Axial neck pain
- Radiculopathy
- Combination
- (M.A.R.C.)
XR findings of cervical spondylosis (5)
- Facet hypertrophy
- Loss of disc height
- Loss of cervical lordosis
- Osteophytes
- Subchondral sclerosis/cysts
- (F.L.L.O.S.)
MRI findings of cervical spondylosis (5)
- Soft disc herniations
- Foraminal stenosis (uncovertebral joint spurs)
- Decreased SAC
- Myelomalacia
- Ligamentum flavum hypertrophy
- (Front → back)
Surgical options for cervical spondylosis (5)
- Anterior cervical discectomy and fusion
- Cervical disc arthroplasty
- Posterior keyhole laminoforaminotomy
- Laminoplasty
- Posterior cervical laminectomy and fusion
- (Front → back)
Indications for surgical intervention in cervical spondylosis (5)
- Myelopathy
- Radiculopathy unresponsive to treatment
- SAC ≤ 13 mm with myelomalacia in an asymptomatic patient
- Intractable neck pain with1 or 2 level disease
Indications for cervical laminoplasty (3)
- Preserved cervical lordosis
- Multilevel anterior compression
- Ossification of the posterior longitudinal ligament)
Complications of cervical laminoplasty (3)
- Decreased range of motion
- Axial neck pain
- Kyphosis
Causes of cervical Myelopathy
- Congenital stenosis
- Ossification of the posterior longitudinal ligament
- Acquired stenosis (spondylosis, tumor, infection)
- Loss of cervical lordosis
- (C.O.A.L.)
Clinical findings of cervical Myelopathy (6)
- Upper extremity clumsiness
- Myelopathy hand
- Sensory abnormalities
- Upper motor neuron findings
- Bowel/bladder dysfunction
- Gait abnormalities (broad-based gait)
- (Upper → lower)
Ranawat classification of cervical myelopathy (4)
- 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
Nurick myelopathy scale (5)
- 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
Imaging findings of cervical myelopathy (4)
- 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)
Types of clinical course of cervical myelopathy (Clark & Robinson) (3)
- Stable (75%)
- Slow, steady decline (20%)
- Rapid decline (5%)
Factors in decision-making process for surgical treatment of cervical myelopathy (4)
- Location of compression
- Alignment of the spine
- Number of involved levels
- Nature of compression (soft tissue vs. bone)
Indications for cervical disc arthroplasty (5)
- 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
Contraindications to cervical disc arthroplasty (10)
- AS, RA, OPLL, DISH
- IDDM
- Osteoporosis
- Obesity
- Pregnancy
- Neck Pain without Objective Evidence
- Cervical Instability
- Previous ALIF
- Previous INFECTION
- Previous FRACTURE
Risk factors for cervical spine involvement in rheumatoid arthritis (5)
- Mutilating arthritis
- Males
- Longer duration of disease
- Seropositive disease
- Steroid treatment
- (M.M.L.S.)
Patterns of rheumatoid arthritis involvement in the cervical spine (4)
- Atlantoaxial instability (#1 - 50-80%)
- Basilar invagination (#2 - 40%)
- Subaxial instability (20%)
- Combination (#3)
Indications for surgical intervention in rheumatoid atlantoaxial instability (6)
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
Methods of posterior C1-2 fixation (3)
- Posterior wiring techniques (Brooks, Gallie)
- Transarticular screws (Magerl)
- Posterior screw/rod fixation (Harms technique – C1 lateral mass, C2 pedicle)
