Msk 13

Question 1

Which type of imaging study is the more sensitive, efficient, and cost-effective when it comes to primary imaging for suspected c-spine injury?

Answer 1

CT

Question 2

Which type of Anderson-D’Alonzo Odontoid Fracture (I, II, or III) is more prone to non-union, and requires an anterior screw or posterior C1-2 fusion?

Answer 2

Type II

Question 3

The 2007 Subaxial Cervical Spine Injury Classification depends on what 3 conditions?

Why is this useful?

Answer 3

Injury morphology (compression, burst, distraction, rot-trans)

Diskoligamentous complex integrity

Neuro status (root injury, complete/incomplete cord injury)

Useful for selecting non-surgical vs surgical treatment

Question 4

Cervical dislocation requires what 3 interventions?

What is the concern with cervical disclocation?

Answer 4

Timely controlled realignment

Decompression

Surgical stabilization

Concern for traumatic disk herniation

Question 5

What is the most common incomplete pattern of spinal cord injury?

Answer 5

Central cord syndrome

• incomplete tetraplegia
• older, stenotic, spondylotic spine, no fracture or instability, stable to improving neuro status

Question 6

In terms of thoracic and lumbar trauma, where does the most common fracture occur (52%)?

Answer 6

thoracolumbar junction

Question 7

According to the Three-column model of Denis for fracture stability, which column(s) are:

Stable

May be unstable

Unstable

Answer 7

Stable: Anterior

May be unstable: Anterior & middle

Unstable: 3-column injury

Question 8

In terms of vertebral body compression fractures, what are the causes of a pathologic fracture (low or no-energy fracture)?

Answer 8

Osteoporosis

Meetastasis/primary neoplasm

Kyphoplasty is a surgical option for intractable pain, otherwise non-operable if stable

Question 9

This type of fracture causes compression of anterior and middle column, and the posterior vertebral body is repulsed into spinal canal

Answer 9

Burst fracture

Question 10

This type of injury is due to separation of vertebral elements due to bony or ligamentous injury.

Answer 10

Distraction Injury

Question 11

What are the two types of distraction injuries?

Answer 11

Flexion-distraction (seat-belt or Chance)

Extension-distraction (seen in ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis)

Question 12

Unstable (3-column) injury treated with posterior fusion.

Neuro deficit is common.

Answer 12

Translation-Rotation Injury (Fracture-Dislocation)

Question 13

What is the gold standard confirmatory test for Radiculopathy?

Answer 13

MRI

Question 14

What are the surgical options for radiculopathy that manifests progressive neuro deficit and a failed 6 weeks of non-operative care?

Answer 14

Anterior cervical discectomy and fusion (ACDF)

Disc arthroplasty

Posterior foraminotomy/Discectomy

Question 15

Symptomatic cord compression due to pathologic disc, ligament, and/or osteophyte. H&E is often vague compared to radiculopathy. Diffuse weakness, numbness, clumsy, loss of fine motor, gait disturbance, spasticity.

What is the diagnosis and treatment?

Answer 15

Spondylotic myelopathy

Surgical decompresion +/- fusion

ACDF, corpectomy & fusion, posterior laminectomy & fusion or laminoplasty