Miller's Review Spine Flashcards
Ortho spine review
SPECT CT commonly used to evaluate ___
Spondylolysis. SPECT is a bone scan overlying a CT scan
Most common lumbar levels of spondylosis
L4-5 > L5-S1 > L3-L4
MRI findings in lumbar spondylosis
As the nucleus pulposis degenerates, you get decreased T2 signal in the disc (dark disc disease)
Physical exam maneuvers for discogenic back pain
Straight leg raise with radicular symptoms and femoral stretch with radicular symptoms
1st step in pathway of disc degeneration
Tear in annulus fibrosus
Nerve block for facetogenic back pain
Medial branch of dorsal rami
Most common direction for disc herniations
Posterolateral, adjacent to the stout posterior longitudinal ligament
Most common nerve compressed in lumbar disc herniation?
L5 root. L4-L5 disc herniation is the most common, posterolateral is most common, so it compresses the traversing L5 nerve root (not the exiting L4 nerve root at the L4-L5 level)
What nerve root is likely compressed at this disc herniation at L4-L5?
This is a far lateral herniation that would compress the EXITING nerve root at L4-L5, which is L4.
Indications for operative management in lumbar disc hernation?
Cauda equina, weakness or failure of conservative management. DO NOT FUSE unless they have instability
Indications for fusion with herniatic lumbar disc
Multiple recurrent HNP
Treatment of single recurrent herniated disc?
Microdiscectomy without fusion
Outcomes in far lateral disc herniation treated with Wiltse approach
Not as well as central disc herniation treatment, persistent radiculopathy in some
How does vascular claudication differ from neurogenic claudication
In vascular claudication patients have no pain when standing still, they have pain when walking up a hill (better going uphill in neurogenic, worse going down hill), pain on stationary bike and pain starts in feet (buttock in neurogenic)
Surgical management of lumbar stenosis
Don’t need to fuse unless evidence of instability or severe foraminal stenosis that may render the segment unstable with facet resection
SPORT trial for lumbar stenosis
Surgery did better than non-op group
Pediatric spondylolysis prognosis
If Meyerding grade I or II by skeletal maturity, they do not slip more. Grades III and IV tend to progress.
6 types of spondylolisthesis
Dysplastic (presents ages 4-6 w/high grade slip, kyphosis and neurologic sx), isthmic, degenerative, traumatic, pathologic and iatrogenic
Treatment of high grade dysplastic spondylolisthesis in a child?
Fusion. Can do L5-S1 in situ fusion which leaves residual deformity, but reduces risk to L5 nerve root with reduction of the slip
When do adolescents with low grade isthmic spondylolysis get nerve compression symptoms?
As they age, the disc degenerates and they get “up down” foraminal stenosis
Surgical treatment of adult isthmic spondylolisthesis
Interbody fusion improves rates of fusion
Most common level for degenerative spondylolisthesis
L4-L5
Cause of degenerative spondylolisthesis
Incompetent facet joints lead to spondylolisthesis, compression is usually central or lateral recess
Surgical treatment of degenerative spondylolisthesis
Decompression only if <5mm movement on flex-ext views. If unstable, fusion