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Surgery II - OSCE > L8: Spinal Degenerative Diseases > Flashcards

L8: Spinal Degenerative Diseases Flashcards

1
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2
Q

Pathology in Degenerative Disease of the Spine

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3
Q

Symptoms of Spinal Degenerative Diseases

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4
Q

Red Flags of Spinal Degenerative Diseases

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5
Q

Red Flags of Spinal Degenerative Diseases

  • Cauda Equina Syndrome
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6
Q

Red Flags of Spinal Degenerative Diseases

  • Myelopathy
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7
Q

Red Flags of Spinal Degenerative Diseases

  • Radiculopathy
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8
Q

Red Flags of Spinal Degenerative Diseases

  • Others
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9
Q

RF for Spinal Degenerative Diseases

A
  • Aging.
  • Genetic predisposition.
  • Smoking, diet, weight.
  • Occupational (heavy lifting).
  • Sedentary lifestyle.
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10
Q

Types of Spinal Degenerative Diseases

A

A) Disc bulge.
B) Annular tear.
C) Herniation.

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11
Q

Def of Disc Bulge

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12
Q

Types of Annular Tear

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13
Q

Def of Disc Herniation

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14
Q

Types of Disc Herniation

A

Notes

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15
Q

Types of Disc Herniation

  • Protrusion
A

The base of the herniated disc material is broader than the apex.

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16
Q

Types of Disc Herniation

  • Extruded Disc Herniation
A

The base of the herniation is
narrower han the apex (toothpaste sign)

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17
Q

Types of Disc Herniation

  • The Third Type?
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18
Q

Regions Affected by Disc Herniation

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19
Q

Epidemeology of Lumbar Disc Prolapse

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20
Q

Classification of Lumbar Disc Prolapse

A
  • According to Location
  • According to Anatomy
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21
Q

Classification of Lumbar Disc Prolapse

  • Acoording to location
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22
Q

Classification of Lumbar Disc Prolapse

  • Central Prolapse
A
  • Often associated with back pain only
  • May present with Cauda equina syndrome (surgical emergency)
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23
Q

Classification of Lumbar Disc Prolapse

  • Posterolateral Prolapse (Paracentral)
A
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24
Q

Classification of Lumbar Disc Prolapse

  • Foraminal Prolapse (Far Lateral, Extraforaminal)
A
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25
Q

Classification of Lumbar Disc Prolapse

  • Axillary Prolapse
A

Can affect Both exiting and descending nerve roots

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26
Q

Classification of Lumbar Disc Prolapse

  • According to Anatomy
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27
Q

Dx of Lumbar Disc Prolapse

A
  • Physical Examination
  • Imaging
  • Neurophysiological
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28
Q

Dx of Lumbar Disc Prolapse

  • Imaging
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29
Q

Symptoms of Lumbar Disc Prolapse

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30
Q

Def of Cauda Equina Syndrome

A

Serious neurologic condition in which damage to the cauda equina

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31
Q

Symptoms of Cauda Equina Syndrome

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32
Q

Lumbar Disc Prolapse

  • L4
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33
Q

Lumbar Disc Prolapse

  • L5
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34
Q

Lumbar Disc Prolapse

  • S1
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35
Q

Provocative Tests in Lumbar Disc Prolapse

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36
Q

DDx of Lumbar Disc Prolapse

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37
Q

Management of Lumbar Disc Prolapse

A

1) Conservative (Non operative)

2) Selective nerve root corticosteroid injections

3) Surgical

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38
Q

Management of Lumbar Disc Prolapse

  • Conservative
A
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39
Q

Conservative Management of Lumbar Disc Prolapse

  • Indications
A

1) First line of treatment for most patients with disc herniation

2) 90% improve without surgery

40
Q

Conservative Management of Lumbar Disc Prolapse

  • Methods
41
Q

Selective Nerve Root Corticosteroids Injections of Lumbar Disc Prolapse

42
Q

Selective Nerve Root Corticosteroids Injections of Lumbar Disc Prolapse

  • Indication
A

Second line of treatment if therapy and medications fail

43
Q

Selective Nerve Root Corticosteroids Injections of Lumbar Disc Prolapse

  • Methods
A
  • Epidural
  • Selective nerve block
44
Q

Selective Nerve Root Corticosteroids Injections of Lumbar Disc Prolapse

  • Outcome
A
  • Leads to long lasting improvement in 50% compared to ~90% with surgery)
  • Results best in patients with extruded discs is opposed to contained
45
Q

Surgical TTT of Lumbar Disc Prolapse

46
Q

Surgical TTT of Lumbar Disc Prolapse

  • Indications
47
Q

Surgical TTT of Lumbar Disc Prolapse

  • Methods
48
Q

Complications of Surgical TTT of Lumbar Disc Prolapse

49
Q

Symptoms of Cervical Disc Prolapse

50
Q

Symptoms of Cervical Disc Prolapse

  • Sites Affected
A

1) Back of the skull
2) Neck
3) Shoulder girdle
4) Scapula
5) Arm and hand.

51
Q

Symptoms of Cervical Disc Prolapse

  • Examples
A

1) Pain (neck, shoulder, arm, hand).

2) Radiculopathy.

3) Numbness.

4) Muscle weakness.

5) Paresthesia.

6) Severe cases: myelopathy + sphincteric disturbance (urinary incontinence and loss of bowel control).

52
Q

Symptoms of Cervical Disc Prolapse

  • C4/C5
53
Q

Symptoms of Cervical Disc Prolapse

  • C5/C6
54
Q

Symptoms of Cervical Disc Prolapse

  • C6/C7
55
Q

Symptoms of Cervical Disc Prolapse

  • C7/T1
56
Q

Dx of Cervical Disc Prolapse

A
  • Ex
  • Radiology
57
Q

Dx of Cervical Disc Prolapse

  • Ex
58
Q

Dx of Cervical Disc Prolapse

  • Cervical Compression Test & (Spurling’s test)
59
Q

Dx of Cervical Disc Prolapse

  • Lhermitte Sign
A

Feeling of electrical shock with patient neck flexion

60
Q

Dx of Cervical Disc Prolapse

  • Hoffman Sign
61
Q

Dx of Cervical Disc Prolapse

  • rads
62
Q

TTT of Cervical Disc Prolapse

63
Q

TTT of Cervical Disc Prolapse

  • Conservative
A
  • Medications (NSAID).
  • Physical therapy and exercise.
  • Steroid injection.
64
Q

TTT of Cervical Disc Prolapse

  • Surgery
65
Q

Def of Spinal Canal Stenosis

A

Abnormal narrowing (stenosis) of spinal canal that may occur in any of the regions of the spine → restriction to the spinal canal → neurological deficit

66
Q

Risk Factors for Lumbar Canal Stenosis

A

1) Caucasian race

2) Increased BMI

3) Congenital spine anomalies (20%)

4) Failure of posterior elements to develop, short pedicles and laminae

67
Q

Classification (Types) of Lumbar Canal Stenosis

A

1) Central stenosis
2) Lateral recess stenosis
3) Foramen stenosis
4) Extraforaminal Stenosis

68
Q

Symptoms of Lumbar Canal Stenosis

69
Q

Symptoms of Lumbar Canal Stenosis

  • Neurogenic Claudication
70
Q

Signs of Lumbar Canal Stenosis

71
Q

Management of Lumbar Canal Stenosis

A
  • Non-Operative
  • Operative
72
Q

Management of Lumbar Canal Stenosis

  • Non-Operative
73
Q

Non-Operative Management of Lumbar Canal Stenosis

  • Modalities
A

Oral medications, physical therapy, and corticosteroid injections

74
Q

Non-Operative Management of Lumbar Canal Stenosis

  • Indications
A

First line of treatmen

75
Q

Non-Operative Management of Lumbar Canal Stenosis

  • Modalities (Explained)
A

1) NSAIDS, physical therapy, weight loss and bracing:
- Preoperative opioid use associated with prolonged hospital stays and increased postoperative pain.

2) Steroid injections (epidural and transforminal):
- Found to be effective and may obviate the need for surgery

76
Q

Surgical Management of Lumbar Canal Stenosis

77
Q

Surgical Management of Lumbar Canal Stenosis

  • Wide PTP Decompression
78
Q

Surgical Management of Lumbar Canal Stenosis

  • Wide PTP Decompression with instrumented fusion
79
Q

Def of Spondylosis

A
  • Broad term meaning degeneration of the spinal column from any cause.
  • In the more narrow sense it refers to spinal osteoarthritis, age-related wear and tear of the spinal column (most common cause of spondylosis)
80
Q

Def of Spondylolishthesis

A

An anterior displacement of a vertebra relative to the vertebra below.

81
Q

Grading of Spondylolishthesis

82
Q

Etiological Classification of Spondylolishthesis

83
Q

CP of Spondoylolishthesis

84
Q

Management of Spondoylolishthesis

A
  • Non Operatice
  • Operative
85
Q

Management of Spondoylolishthesis

  • Non-Operative
86
Q

Non-Operative Management of Spondoylolishthesis

  • Examples
A

Oral medications, lifestyle modifications, therapy

87
Q

Non-Operative Management of Spondoylolishthesis

  • Techniques
A
  1. Activity restriction.
  2. NSAID.
  3. Role of injections unclear.
  4. Bracing may be beneficial especially in the acute phase.
88
Q

Non-Operative Management of Spondoylolishthesis

  • Indications
A

Most patients can be treated nonoperatively

89
Q

Operative Management of Spondoylolishthesis

A
  • L5-S1 Decompression & Instrumented Fusion +- Reduction
  • L4-S1 Decompression & Instrumented Fusion +- Reduction
  • ALIF
90
Q

Operative Management of Spondoylolishthesis

  • L5-S1 Decompression & Instrumented Fusion +- Reduction
91
Q

Operative Management of Spondoylolishthesis

  • L5-S1 Decompression & Instrumented Fusion +- Reduction (Indications)
92
Q

Operative Management of Spondoylolishthesis

  • L5-S1 Decompression & Instrumented Fusion +- Reduction (Reduction)
93
Q

Operative Management of Spondoylolishthesis

  • L4-S1 Decompression & Instrumented Fusion +- Reduction
94
Q

Operative Management of Spondoylolishthesis

  • L4-S1 Decompression & Instrumented Fusion +- Reduction (Indications)
95
Q

Operative Management of Spondoylolishthesis

  • ALIF
96
Q

Operative Management of Spondoylolishthesis

  • ALIF (Indications)
97
Q

Operative Management of Spondoylolishthesis

  • ALIF (Outcomes)

Surgery II - OSCE (20 decks)

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