OITE - Spine Flashcards
Smallest pedicle diameter in Lumbar spine?
L1
Which pedicle screws are the most medial pointing?
Sacral screws
What is neurologic level?
Lowest segment were sensory and motor function are normal on both sides
ASIA E?
Motor and sensory is normal.
ASIA B?
“Barely anything” - sensory but no motor
ASIA C
More than half of the muscles have a grade 3 or less
ASIA D
More than half of key muscles are grade 3 or more
Spinal shock, bulbo-cavernous reflex present or absence?
Absent
Spinal shock, define. 3 items
- Flaccid areflexic paralysis
- Bradycardia and hypotension
- Absent bulbocavernous reflex
What percent of SCI patients suffer from MDD (depression)?
11%
What is the most common cardiac arrhythmia in acute stage following SCI?
Bradycardia
Contraindications to high dose prednisone in acute SCI?
- GSW
- Pregnancy
- Under 13 yo
- > 8 hrs after injury
- Brachial plexus injury
Loading dose for high dose methylprednisone? Drip?
1) Load 30mg/kg over 1st hour
2) Drip 5.4 mg/kg/hr
- for 23 hr if started less 3hr after injury, -for 47h if >3h after injury
Functional electrical stimulation in rehab of SCI, has greatest functional effect on what?
Skeletal muscle activation
In the lateral corticospinal tract, UE or LE is more medial in the cord?
The UE
Central cord syndrome? Prognosis?
- UE motor (hands worse than arms) worse than LE
- Good prognosis, bowel bladder function will return, residual hand clumsiness
In Central Cord syndrome, which tract is injured contributing to the greatest motor function deficits?
Lateral corticospinal tract
Brown-Sequard SCI, motor and sensory findings?
- Ipsilateral deficit in LCS tract (motor) and dorsal column (deep touch)
- Contralateral deficit in LST (pain/temp)
- Usually due to a penetrating injury
Os Odontodieum with neuro deficits, treatment?
Posterior C1-C2 fusion
What is atlanto-axial instability? Adult causes?
- C1 on C2 instability
- Degenerative: Downs, RA, Os odontoideum
- Traumautic: Type 1 odontoid fx, atlas fx, TL injuries
Type 1 odontoid fx typically a result of which ligament avulsion?
Alar ligament
Which Type odontoid fx is at watershed area?
Type 2 odontoid fx, sit below transverse ligament
Which type of odontoid fx involves the C1-2 facet?
Type 3 odontoid fx. Heals well
Which ondontoid fx do you treat with cervical orthosis?
Type 1 and Type 3
How do you treat type 2 odontoid fx?
1) Young pt, and if risk factors for nonunion - SURGERY
2) Young pt, if no risk factors for non-union - HALO
What are risk factors for non-union for Type 2 odontoid?
- > 5mm displacement (posterior displacement)
- fx comminution
- angulation >10 deg
- age >50 - delay in treatment
In atlas and TL lig injuries, what can you treat with hard collar?
- Stable Type 1 fx (intact TL)
- Stable Jefferson fx (type 2) (intact TL)
- Stable Type 3 fx (intact TL)
Halo vest is most effective at controlling which spinal motion?
Atlanto-axial rotation
What are 3 possible neurologic complication with halo traction? Most common?
- Abducen nerve palsy (most common) - deficit in lateral gaze
- Supraorbital nerve palsy
- Supratrochlear nerve plasy
In Which patients is laminoplasty alone contraindicated?
Rigid cervical kyphosis of > 13 deg
Most common post-operative complication for cervical myelopathy?
- Postop C5 palsy (equivalent with posterior and anterior)
- Biceps weakness
Which pedicle has smallest diameter overall?
T4
Complications of surgical tx of cervical radiculopathy?
- Pseudoarthrosis (5 to 10% single level, 30% multilevel)
- Recurrent laryngeal nerve injury
- Hypoglossal nerve injury
Higher or lower fusion rate, in cervical spine posterior fusion revision surgery (done for pseudoarthrosis)?
higher fusion rate
Difference between nerve root anatomy cervical vs lumbar
- C8 and above pedicle/nerve root mismatch
- horizontal anatomy cervical nerve root, vertical anatomy lumbar nerve root
What are Waddel’s signs?
Look for malingering (non organic back pain). Look for 3
- superficial non anatomic tenderness, -neg SLR with patient distraction, -pain with axial compression or simulated rotation of spine
- lower extremity numbness in a non-dermatomal pattern
What is pelvic incidence?
PI = PT + SS
is pelvic incidence a fixed or changing parameter?
Fixed paramater you are born with
In adult spinal deformity, what is most reliable indicator for decrease in overall disability?
Correcting sagittal vertical axis (SVA), to within 5 cm of neutral.
Risks of pseudoarthrosis in correction of adult spinal deformity?
- Smoking
- Kyphosis >20deg
- Hip OA, +ve Sag Balance >5cm
- age > 55, -incomplete sacro-pelvic fixation
Juvenile Ankylosing spondylitis features?
Enthesitis, kyphosis, sacroilitis, spinal stiffness, syndesmophytes
Reiter Syndrome mnemonic?
Cant see (uveitis) Cant pee (urethritis) Cant climb up a tree (arthritis)
Pseudosubluxation of cervical spine, what is Swischuk’s line?
Draw spinolamellar lines of C1-3.
Spinolaminar point on C2 should be within 1.5mm of that line
Pseudosubluxation of cervical spine, most common location? second most common?
C2 on C3 most common
C3 on C4 is second most common
AARD (atlanto-axial rotatory displacement)?
- Is a common cause of childhood torticollis
- mild subluxation to fixed facet dislocation
- trauma or retropharyngeal irritation (Grisel’s disease)
What is the tx for AARD (Grisel’s), that persists for 1 week? 1 month? 3 month?
1wk - halter traction and bracing
1 month - halo
3 month - operative
What is Klippel-Feil syndrome?
Congenital cervical fusion with triad of
- low posterior hairline
- short webbed neck
- limited neck motion
How to measure sagittal imbalance (sagittal vertical axis offset)?
C7 plumb line (dropped from centre of C7 v body), to postero-superior corner of S1 v body on standing lateral.
Pathologic scoliosis, causes?
- osteoid osteoma
- osteoblastoma
Osteoid osteoma?
- Occur in apex of concavity of the curve
- curves are typically rigid
- can occur in vertebral body or posterior elements
- same histology as peripheral skeletal lesions
What is the risks with reduction of L5-S1 spondylolistheiss?
L5 most common nerve root injury with reduction
Treatment of L1-L4 pars interarticularis defect? L5-S1?
L1-4: Pars repair.
L5-S1: fusion
