Low Yield Flashcards
When does the secondary ossification center of the odontoid process appear and fuse?
Appears at age 3 and fuses at age 12
What level does the spinal cord end?
L1
What level does the spinal cord end?
L1
Where does the C5 nerve root exit and how does this differ from the thoracic and lumbar spine?
C5 exits above the C5 pedicle
Thoracic and lumbar nerve roots exit below the corresponding spinal segment
Where does the C5 nerve root exit and how does this differ from the thoracic and lumbar spine?
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)
What muscles can be tested to assess lumbar and sacral nerve function?
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)
In the lumbar spine what is important about location of disc herniation?
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.
Which lumbar vertebrae has the smallest pedicle diameter?
L1; used to template pedicle screws
Which lumbar vertebrae has the smallest pedicle diameter?
L1; used to template pedicle screws
Which thoracic vertebrae has the smallest pedicle diameter and length?
T4
What are the key features of cauda equina syndrome?
bilateral leg pain
bowel and bladder dysfunction
saddle anesthesia
lower extremity sensorimotor changes
What is the timing for surgical release of cauda equina syndrome?
48hrs
Spear tackling is associated with what chronic condition?
Cervical stenosis; “Spear tacklers spine”
What treatment for synovial facet cysts leads to less recurrence?
Facetectomy and instrumented fusion
What are the types of disk herniation?
Bulging- annulus intact
Extruded- through annulus but PLL intact
Sequestered- disk material is free in th canal
What is the most common complication of endoscopic transthroacic anterior surgery for disc herniation?
intercostal neuralgia
Provactive discography can lead to what?
Acceleration of disk degeneration
When are VEPTR rods indicated?
In juvenile idiopathic scoliosis in children with curve >50° and significant growth remaining
What common disorder causes back pain and is described as non-marginal syndesmophytes that affect 3 or more levels of the spine?
DISH (Diffuse Idiopathic Skeletal Hyperostosis)
What are some findings that distinguish DISH from ankylosing spondylitis?
DISH has preserved disc spacer, occurs in older people, no SI involvement
What spinal condition has in increased risk of HO in THA?
DISH
In a 5yo patient with reducible spinal deformity and no history of cervical trauma, likely has?
Pseudosubluxation of the cervical spine;
Most common at C2-3
Which spinal deformity is associated with a Sprengel’s deformity and alantoaxial instability?
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
What is the typical treatment for congenital muscular torticolis?
Passive stretching; 90% respond to tx in first year
If limitation >30° or present for > 1yr can perform surgical release
What are the three patterns of cervical instability a/w rheumatoid?
1) Atlantoaxial subluxation (most common)
2) basilar invagination
3) subaxial subluxation
Which radiographic marker may predict neural recovery after decompression in a patient that has rheumatoid with AA subluxation?
Posterior atlanto-den interval of >13mm (also known as space available for cord)
Which type of congenital scoliosis has the greatest potential of progressing?
Unilateral unsegmented bar with contralateral hemivertebra; up to 10° per year
What studies are important to obtain in patients with congenital scoliosis?
Renal US or MRI
Echocardiogram
What is Scheuerman’s disease?
A rigid thoracic hyperkyphosis of >45 degrees;
Does not correct with hyperextension
What are the most commons of disc space infections?
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
What pathologic condition can lead to scoliosis?
Osteoid osteoma; lesion is at the apex of the concavity
can resolve after tumor resection (en bloc most common)
