Neurospine Flashcards
When placing bicortical sacral pedicle screws, which structure is at most risk with a laterally placed screw that perforates the anterior cortex?
a. S1 nerve root
b. L5 nerve root
c. Lumbosacral plexus
d. Internal Iliac artery
e. Aorta
b. L5 nerve root
A diabetic patient with known peripheral vascular disease undergoes an anterior cervical discectomy at C4-5. The operative course is unremarkable; however, in the recovery room the patient is noted to have decreased sensation in the 4th and 5th digits of the left hand and decreased grip. What is the MOST likely diagnosis?
a. Residual muscle relaxation
b. Brachial plexus stretch injury
c. Embolic stroke
d. Surgical trauma
e. Positioning nerve injury
e. Positioning nerve injury
A 68 year-old male with a history of prostatic cancer presents with low-grade fever and severe low back pain progressing to include lower extremity numbness. Thoracic CT shows extensive destruction of the T11 and T12 vertebral bodies with relative sparing of the T11-12 disc space, as well as a large paraspinous abscess with calcification. Thoracic MRI shows a kyphotic deformity with enhancing soft tissue and bone extending into the anterior spinal canal and resulting in moderate stenosis and spinal cord compression. The MOST likely pathologic process is:
a. Discitis - Staph epidermidis
b. Osteoporotic compression fracture
c. Pathologic fracture
d. Spinal tuberculosis
e. Discitis - Staph aureus
d. Spinal tuberculosis
A 12 year-old with Down syndrome has abnormal flexion-extension cervical spine x-rays. The child has no significant neurologic complaints or neck pain. On exam, the child has full range of motion and no tenderness to palpation. The flexion-extension x-rays show a 7-8 mm atlantodental interval in flexion which reduces to 4 mm in extension. What is the most appropriate next step?
a. C1-2 wiring with halo placement and autologous fusion
b. Occipital cervical fusion with sublaminar wires
c. Observation with no repeat imaging necessary
d. C1-2 transarticular screw placement and autologous fusion
e. Observation with repeat flexion-extension in the future
e. Observation with repeat flexion-extension in the future
What characteristic imaging finding on MRI would best differentiate neuromyelitis optica from multiple sclerosis?
a. Multiple enhancing intramedullary spinal lesions spanning 1-2 segments.
b. Presence of high burden of periventricular, juxtacortical and infratentorial demyelinating lesions.
c. Multiple non-enhancing intramedullary spinal lesions spanning 1-2 segments.
d. Optic nerve enhancement.
e. An intramedullary spinal cord lesion spanning 3 or more segments.
e. An intramedullary spinal cord lesion spanning 3 or more segments.
The radiographic and magnetic resonance imaging findings at L2-L3 (shown in Figures 1-3) are most consistent with a diagnosis of:
a. fracture.
b. metastatic carcinoma.
c. degenerative disc disease.
d. chordoma.
e. discitis/osteomyelitis.
e. discitis/osteomyelitis.
A 47 year-old woman underwent a C5-6 ACDF via a left sided approach. Postoperatively, she has a weak, drooping eyelid and a constricted pupil. What technique reduces risk of this complication?
a. Minimize excessive traction on the shoulders when positioning
b. Deflate and re-inflate the endotracheal balloon after retractor placement
c. Place retractors under the medial edge of the longus colli muscles during periosteal dissection
d. Minimize distraction of the vertebral bodies
e. Perform surgical approach from the patient’s right side
c. Place retractors under the medial edge of the longus colli muscles during periosteal dissection
A 60 year old man presents with 3 months of worsening diffuse severe unremitting left upper extremity pain, parasthesias, and hand weakness. Exam shows 4/5 weakness of hand muscles including abductor pollicus brevis and all intrinsics, scattered sensory loss on the ulnar side of the forearm, normal deep tendon reflexes and no evidence of myelopathy. MRI of the cervical spine shows mild degenerative changes throughout the neck. What imaging study would assist in the diagnosis?
a. Thermogram
b. Scoliosis survey
c. Chest CT
d. Bone scan
e. Cervical spine flexion-extension x-rays
c. Chest CT
What is the most common indication for surgical treatment of Scheuermann’s thoracic kyphosis?
a. Radiculopathy from disc herniation
b. Painful kyphosis
c. Severe compression fractures
d. Pulmonary compromise
e. Progressive scoliosis
b. Painful kyphosis
Failure to account for which radiographic measurement is associated with delayed treatment failure after surgical treatment of positive sagittal imbalance?
a. Central Sacral Vertical Line
b. Pelvic Incidence
c. Sacral Slope
d. Thoracic kyphosis
e. Lumbar coronal Cobb angle
b. Pelvic Incidence
A 55 year-old female presents with back pain, progressive right leg pain, atrophy and weakness. Exam reveals bilateral non-dermatomal lower extremity hypalgesia and a hemangioma with hypertrichosis over the lumbar spine. Imaging reveals a 10 degree thoracic scoliosis, right sided disc bulge at L1/2, conus terminating at L4, and a fatty filum terminale (3mm). What is the treatment of choice for this patient?
a. Spinal deformity correction
b. Monitoring with serial imaging
c. Conservative therapy (PT, NSAIDS, etc)
d. Release of filum terminale
e. L1/L2 microdiscectomy
d. Release of filum terminale
A 35-year-old woman presents with an L1 burst fracture after a motor vehicle accident. Which of the following characteristic(s) predicts likelihood of instrumentation failure with short segment posterior instrumented fusion?
a. Spinal canal compromise > 50%
b. Comminuted fracture with fragment displacement and kyphosis
c. Involvement of both vertebral endplates
d.Incomplete neurologic deficit
e. Disrupted posterior ligamentous complex
b. Comminuted fracture with fragment displacement and kyphosis
A 76 year-old man presents with worsening back pain unresponsive to conservative measures. 36-inch radiographs were performed at his office visit (Figure 1). What Schwab grade osteotomy (Figure 2) will provide the best correction of his sagittal plane deformity over one segment?
a. Grade 1
b. Grade 5
c. Grade 4
d. Grade 3
e. Grade 2
e. Grade 2
What is the first priority in the overall assessment of a trauma patient with an acute cervical spine fracture?
a. Spinal stability
b. Blood pressure
c. Neurological deficit
d. Airway integrity
e. Ongoing hemorrhage
d. Airway integrity
What is the definitive treatment of atlanto-occipital dislocation (AOD)?
a. Observation with serial radiographs
b. Cervical traction
c. Halo vest immobilization
d. Cranio-cervical internal fixation and fusion
e. Rigid cranio-cervico-thoracic orthosis
d. Cranio-cervical internal fixation and fusion
A 6 year-old girl presents with progressive scoliosis. Physical examination reveals a club foot and a midline hairy nevus in the lumbar region. MRI is shown (Figure 1). What is the most likely diagnosis?
a. Diastematomyelia
b. Dermal sinus tract
c. Neurenteric cyst
d. Myelomeningocele
e. Lipomyelomeningocele
a. Diastematomyelia
A 46-year-old IV drug abuser presents with a 2 week history of fever and progressive low back pain. He is neurologically intact. MRI reveals increased T2 signal in the L3-4 disc space with endplate destruction without an appreciable fluid collection. There is no evidence of instability or segmental kyphosis. Blood cultures are negative. What is the most appropriate next step in management?
a. Needle biopsy of disc space
b. Laminectomy for surgical debridement
c. Empiric antibiotics
d. Posterior instrumentation and fusion without laminectomy
e. Anterior discectomy and interbody fusion
a. Needle biopsy of disc space
In a patient with traumatic quadriparesis and difficulty breathing, vertical displacement of the occipital condyles from the lateral masses of C1 is most consistent with rupture of what soft tissue structures?
a. Rupture of the anterior longitudinal ligament.
b. Rupture of ligamentum flavum.
c. Rupture of the transverse ligament.
d. Rupture of the tectorial membrane and alar ligaments.
e. Rupture of the posterior longitudinal ligament.
d. Rupture of the tectorial membrane and alar ligaments.
A patient awakens from left-sided costotransversectomy at T10 for resection of a ventral metastatic tumor with complete paraplegia and loss of pain and temperature sensation. His sensation to light touch in the lower extremities is spared. Post operative MRI reveals no evidence of spinal cord compression or hematoma. What is the most likely diagnosis?
a. Weber’s Syndrome
b. Posterior cord syndrome.
c. Central cord syndrome.
d. Anterior cord syndrome.
e. Brown-Sequard syndrome.
d. Anterior cord syndrome.
Which of the following is considered a major risk factor for osteoporosis by the National Osteoporosis Foundation?
a. Current smoking
b. Prior falls
c. Alcohol use of 1 drink per day
d. High body mass index (BMI)
e. Use of NSAIDS
a. Current smoking
Approximately what percentage of cervical rotation occurs at the C1-2 level?
a. 10%
b. 75%
c. 25%
d. 90%
e. 50%
e. 50%
A patient presents with bilateral nondisplaced fractures through the C2 pars interarticularis (Hangman’s fracture). Flexion-extension dynamic cervical radiographs show 2 mm motion and no significant deformity. What is the most appropriate treatment modality?
a. External immobilization
b. Anterior odontoid screw fixation
c. Anterior C2-3 discectomy and fusion
d. C1-2 transarticular screw fixation
e. Posterior C1-C3 fixation
a. External immobilization
A 47 year-old diabetic woman presents with pain across her buttocks and bilateral lower extremities with ambulation, improved by leaning forward. She reports transient response to epidural injections and no response to NSAIDS and neuropathic pain medication. She has no neurologic deficit. Imaging is shown (figures). What intervention is most likely to best reduce her disability over 4 years?
a. L4-5 laminectomy
b. L4-5 decompression and fusion
c. Long term corticosteroids
d. L4-5 dynamic interspinous spacer placement
e. Bilateral L4-5 hemilaminotomies with preservation of midline structures
b. L4-5 decompression and fusion
A pedicle subtraction osteotomy (PSO) hinges on which anatomic region?
a. The anterior column of the spine
b. Anterior to the spinal column
c. The posterior column of the spine
d. The middle column of the spine
e. Posterior to the spinal column
a. The anterior column of the spine