Low Yield

Question 1

When does the secondary ossification center of the odontoid process appear and fuse?

Answer 1

Appears at age 3 and fuses at age 12

Question 2

What level does the spinal cord end?

Answer 2

L1

Question 3

What level does the spinal cord end?

Answer 3

L1

Question 4

Where does the C5 nerve root exit and how does this differ from the thoracic and lumbar spine?

Answer 4

C5 exits above the C5 pedicle

Thoracic and lumbar nerve roots exit below the corresponding spinal segment

Question 5

Where does the C5 nerve root exit and how does this differ from the thoracic and lumbar spine?

Answer 5

C5 exits above the C5 pedicle

Thoracic and lumbar nerve roots exit below the corresponding spinal segment (L5 nerve root exits at L5-S1 interspace)

Question 6

What muscles can be tested to assess lumbar and sacral nerve function?

Answer 6

L1
L2 hip flexion, adduction (psoas, adductors)
L3 hip flexion, adduction (psoas, adductors)
L4 knee extension (quads)
L5 ankle dorsiflexion (Tib ant), also hip abduction (glut med)
S1 foot plantarflexion (gastroc-soleus)
S2 toe plantarflexion (FHL)

Question 7

In the lumbar spine what is important about location of disc herniation?

Answer 7

A central or paracentral herniation affects the descending nerve root (L4-L5 will affect L5); a lateral herniation affects the exiting nerve root (L4-L5 affects L4).
Remember that lumbar and thoracic nerve roots exits above the vertebrae they are named with.

Question 8

Which lumbar vertebrae has the smallest pedicle diameter?

Answer 8

L1; used to template pedicle screws

Question 9

Which lumbar vertebrae has the smallest pedicle diameter?

Answer 9

L1; used to template pedicle screws

Question 10

Which thoracic vertebrae has the smallest pedicle diameter and length?

Answer 10

T4

Question 11

What are the key features of cauda equina syndrome?

Answer 11

bilateral leg pain
bowel and bladder dysfunction
saddle anesthesia
lower extremity sensorimotor changes

Question 12

What is the timing for surgical release of cauda equina syndrome?

Answer 12

48hrs

Question 13

Spear tackling is associated with what chronic condition?

Answer 13

Cervical stenosis; “Spear tacklers spine”

Question 14

What treatment for synovial facet cysts leads to less recurrence?

Answer 14

Facetectomy and instrumented fusion

Question 15

What are the types of disk herniation?

Answer 15

Bulging- annulus intact
Extruded- through annulus but PLL intact
Sequestered- disk material is free in th canal

Question 16

What is the most common complication of endoscopic transthroacic anterior surgery for disc herniation?

Answer 16

intercostal neuralgia

Question 17

Provactive discography can lead to what?

Answer 17

Acceleration of disk degeneration

Question 18

When are VEPTR rods indicated?

Answer 18

In juvenile idiopathic scoliosis in children with curve >50° and significant growth remaining

Question 19

What common disorder causes back pain and is described as non-marginal syndesmophytes that affect 3 or more levels of the spine?

Answer 19

DISH (Diffuse Idiopathic Skeletal Hyperostosis)

Question 20

What are some findings that distinguish DISH from ankylosing spondylitis?

Answer 20

DISH has preserved disc spacer, occurs in older people, no SI involvement

Question 21

What spinal condition has in increased risk of HO in THA?

Answer 21

DISH

Question 22

In a 5yo patient with reducible spinal deformity and no history of cervical trauma, likely has?

Answer 22

Pseudosubluxation of the cervical spine;

Most common at C2-3

Question 23

Which spinal deformity is associated with a Sprengel’s deformity and alantoaxial instability?

Answer 23

Klippel-Feil syndrome; multiple abnormal segments of cervical spine
Pt can have triad of:
1) short posterior hair line
2) webbed neck
3) limited cervical ROM
Puts must avoid contact sports

Question 24

What is the typical treatment for congenital muscular torticolis?

Answer 24

Passive stretching; 90% respond to tx in first year

If limitation >30° or present for > 1yr can perform surgical release

Question 25

What are the three patterns of cervical instability a/w rheumatoid?

Answer 25

1) Atlantoaxial subluxation (most common)
2) basilar invagination
3) subaxial subluxation

Question 26

Which radiographic marker may predict neural recovery after decompression in a patient that has rheumatoid with AA subluxation?

Answer 26

Posterior atlanto-den interval of >13mm (also known as space available for cord)

Question 27

Which type of congenital scoliosis has the greatest potential of progressing?

Answer 27

Unilateral unsegmented bar with contralateral hemivertebra; up to 10° per year

Question 28

What studies are important to obtain in patients with congenital scoliosis?

Answer 28

Renal US or MRI

Echocardiogram

Question 29

What is Scheuerman’s disease?

Answer 29

A rigid thoracic hyperkyphosis of >45 degrees;

Does not correct with hyperextension

Question 30

What are the most commons of disc space infections?

Answer 30

1) MC in pediatric patients (vessels go to nucleus pulposus)
2) MC in males
3) MC in lumbar region (50-60%)
4) MC bug is s. aureus (>80%)
5) MC see loss of lumbar lordosis (1st radiographic sign), loss of disk space, endplate narrowing, normal to mildly elevated CRP/ESR/WBC

Question 31

What pathologic condition can lead to scoliosis?

Answer 31

Osteoid osteoma; lesion is at the apex of the concavity

can resolve after tumor resection (en bloc most common)