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Questions Flashcards

1
Q

what is the most common nerve complication with halo treatment?

A

abducens nerve palsy - CN VI - this innervates the lateral rectus muscle

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2
Q

what two nerves are at risk if the halo pins are placed too medial? and where do you want the pins placed?

A
  • Supraorbital and supratrochlear nerves

- place them in the lateral 1/3 of the eye below the equator line of the cranium

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3
Q

discuss the anatomy of the ligamentum flavum

A

originates from the ventral surface of the superior lamina and inserts on the more caudal lamina closer to the superior than the inferior edge; often times it is the infolding of the LF that leads to neurogenic claudication; 80% composed of elastic and 20% type I collagen

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4
Q

Indications for ruptured transverse ligament?

A
  • ADI < 3 mm
  • PADI < 14 mm
  • Sum of lateral displacement > 8.2 mm
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5
Q

what is important to remember about immobilization of ankylosing spondy patients for spine injury/fractures?

A

keep them in the injured position; don’t force them into soft/hard collars or reduce them with halo

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6
Q

the IVD ____ in vascularity with age at the ___ ____

A
  • increases

- outer annulus

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7
Q

what study helps to determine the chronicity of compression fractures?

A

MRI

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8
Q

what are the main symptoms of cauda equina? which is the least likely to return after decompressive surgery?

A
  • bowel/bladder incontinence, leg pain, leg weakness, saddle paresthesias
  • bowel/bladder dysfunction
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9
Q

what are the 3 components of TLICS grading system?

A
  1. fracture morphology: compression, burst, translational, distraction
  2. neurological involvement: intact, nerve root, cord compression, cauda equina
  3. PLC: intact, indeterminate, injured
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10
Q

what is the most common cause of non-anesthetic changes for neuromonitoring?

A

patient positioning

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11
Q

what are the symptoms of BSS for incomplete spinal cord injury?

A

contralateral loss of pain and temperature; ipsilateral loss of motor/sensory

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12
Q

Anterior halo pins should be in the ____ third and ____

A
  • lateral 1/3

- below

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13
Q

why can’t you use adult spine boards in children?

A

children have relatively larger heads in proportion to their body so the adult board will cause cervical flexion thus you use peds boards or modified adults boards with depression in the board to fit better

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14
Q

what is the cutoff for administering corticosteroids for spinal cord injuries from the time of injury?

A

8 hrs

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15
Q

What is the most common nerve injury with ACDF? how is the course different on the left than the right? what nerve does it originate from? what are the symptoms of a cervical sympathetic ganglia injury?

A
  • RLE (more than C5 palsy or sympathetic ganlgia)
  • it passes from lateral to midline more cephalad on the right
  • Vagus nerve (CN X) in the carotid sheath
  • pupillary dilation, anhidrosis, and facial drooping
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16
Q

what did the SPORT trial say about operative vs nonoperative treatment of lumbar stenosis?

A

operative had better pain relief, function and patient satisfaction at 2 and 4 years

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17
Q

does DISH or AS have SI joint arthritis? which has diabetes?

A
  • AS

- DISH

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18
Q

Synovial cysts are indicative of ____ pathology; in general you don’t ____

A
  • facet

- non-op these as much with PT, NSAIDs, injections

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19
Q

what type of wheelchair and transfers for C4/5/6/7 cord injuries? (remember the level that is listed is the last normal level)

A
  • electric with puffer controls
  • electric with hand controls
  • manual with slider board transfers
  • independent transfers
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20
Q

with treatment of scoliosis, distraction force ___ with time and lengthening of distraction rods ___ with time

A
  • increases

- decreases

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21
Q

what is the C7 plumb line for measuring sagittal balance?

A

-center of C7 vertebral body to the posterior superior aspect of S1

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22
Q

what is the difference with osteophytes with DISH vs AS?

A

AS is marginal while DISH is non-marginal and ‘flows’ through 4 consecutive vetebrae involving the IVD

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23
Q

Central cord syndrome: most commonly a ____ mechanism with pre-existing cervical stenosis; ___ body more than ___ body motor weakness; distal portion of ____, isolated effects to what spinal tract?

A
  • hyperextension
  • upper
  • lower
  • upper extremity more than more proximal portion
  • lateral corticospinal
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24
Q

thoracic spine herniations: ___% remain asymptomatic; more or less common than cervical and lumbar? what 3 decades of life do they occur? what 1/3 of the T spine are they most common?

A
  • 40%
  • less common
  • 3rd, 4th, 5th
  • lower close to the T-L junction
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25
Q

with spondylolysis, what level can you not do a repair? what is the Gill procedure?

A
  • L5/S1

- it is a wide bilateral decompression and only indicated with neural compromise

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26
Q

how long must someone have smoking cessation postop with spinal fusion surgery to see a difference?

A

6 months

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27
Q

L3 nerve root is measured by what on physical exam?

A

hip adduction

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28
Q

what is predictive of neurologic improvement after treatment of C1/C2 instability with rheumatoid patients?

A

PADI > 10 mm

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29
Q

what is the primary function of aggrecan in the IVD?

A
  • maintain water balance
30
Q

what is a complication after use of PSO for correcting sagittal imbalance?

A

pseudoarthrosis

31
Q

how many mm in the lumbar spine defines critical stenosis? what about CSA?

A
  • 10

- 100

32
Q

with C5 palsy s/p posterior cervical laminectomy, what is the motor/sensory deficit?

A
  • more commonly motor, deltoid weakness
33
Q

damaging the hypoglossal nerve would cause tongue deviation to what side?

A

same side as injury

34
Q

failed disk arthroplasty should be treated with what?

A

arthrodesis

35
Q

compression fx: hardly ever use ___ while ___ is a better option

A
  • vertebroplasty

- kyphoplasthy (much lower pressure with less extravasation)

36
Q

burst fractures: involve ___ and ___ columns, typically instrument ___ above and ___ below, when do you go anterior?

A
  • anterior and middle
  • 3
  • 2
  • neurologic deficits and retropulsion
37
Q

flexion distraction aka ___ fractures typically involve how many columns? fracture dislocation is 3 column injury + ___ component

A
  • chance
  • 3 (anterior column is the axis of rotation)
  • translation
38
Q

what are the 3 axes of the TLICs system? what is the cutoff greater than or equal to for operative?

A
  1. neurologic status
  2. PLC intact or not
  3. fracture morphology
    - 5 (3 or less non-op with 4 being indeterminate)
39
Q

what is the best test for recurrent HNP?

A
  • MRI with gadilinium (increased signal woul be scar where no signal would be another herniation)
40
Q

what approach is usually not indicated in osteomyelitis of the spine?

A
  • posterior, especially in the cervical and thoracic, as the pathology is anterior in the disk
41
Q

Granulomatous infections of the spine: what is the most common organism worldwide? more commonly have ___ and the disk space is ___, what is the Tb tx? same surgical indications as ___

A
  • tuberculosis
  • large abscesses paraspinally
  • preserved unlike pyogenic abscesses
  • triple therapy
  • pyogenic osteo
42
Q

vocal cords abducted means ___, ___ if injured, can get ___ preop for revision ACDF to decide if you can do the other side

A
  • no recurrent laryngeal nerve injury
  • adducted
  • laryngoscopy
43
Q

what are the symptoms of RLN injury? how about superior laryngeal nerve? more common with ___ cervical injuries

A
  • aspiration and hoarseness
  • issues with high phonation
  • upper
44
Q

what is a good pneumonic for halo pins in adults and kids (number and #’s of force)?

A
  • 4 at 8 and 8 at 4
45
Q

conus medullaris typically occurs at what level and what are the symptoms?

A
  • T12/L1

- bowel bladder incontinence without motor symptoms

46
Q

Cervical myelopathy: generally ___ compared to cervical radiculopathy, ___ instability and ___ of the hands, most common cause is ___ changes but also can be ___

A
  • painless
  • gait
  • clumsiness
  • spondylotic
  • tumors, OPLL, epidural abscess and RA
47
Q

what does MS look like on MRI? ___ more than males, dx with MRI ___

A
  • multiple areas of focal demyelination
  • females
  • brain
48
Q

with any cord deformation or myelomalacia the recommendation for contact sports is ___, is a single level ACDF a contraindication to return to play?

A
  • discontinue play

- no

49
Q

what are the 3 cervical spine conditions to look for with RA?

A
  • atlantoaxial subluxation, basilar invagination, subaxial spondylysis
50
Q

Atlantoaxial instability in RA: as ADI increases you get decreased ___, along with myelopathy they will also get __ ___, ADI > ___ mm increase, what PADI is associated with poor prognosis?

A
  • SAC (aka PADI)
  • occipital headaches
  • 3.5 (4.0 with kids)
  • 14 mm
51
Q

Cervical radiculopathy: ___ arm pain with ___ numbness and __ ___ weakness, what are the indications for surgery?

A
  • unilateral
  • dermatomal
  • motor group
  • failed non-operative treatment or pain that isn’t improving x 6-12 weeks **motor weakness is not an indication
52
Q

C6 is your ___ with C7 first ___ and C8 the ___

A
  • thumb
  • 3 fingers
  • pinky
53
Q

Bony Landmarks for ACDF: angle of mandible, hyoid bone, thyoid cartilage, cricoid membrane, carotid tubercle

A
  • C2
  • C3
  • C4-5
  • C5-6
  • C6
54
Q

adjacent segment disease with ACDF plating happens in what 3 scenarios more?

A
  1. women
  2. smokers
  3. with 5 mm of superior end plate
55
Q

Review of spinal cord tracts: lateral corticospinal tract? lateral spinothalamic? ventral spinothalamic? dorsal columns?

A
  • motor
  • pain and temperature
  • light touch
  • vibration and proprioception
56
Q

what are the 3 main arteries to the spinal cord? what level is the artery of adamkiewicz? what does it supply?

A
  1. anterior spinal artery: 2/3 anterior
  2. 2 posterior spinal arteries: 1/3 posterior
    - T8
    - supplies the lower 2/3 of the spinal cord via the anterior spinal artery
57
Q

SEPS: ___ decrease in amplitude or ___ increase in latency; MEPS: positive signal is sustained > ___% drop in amplitude

A
  • 50
  • 10
  • 75
58
Q

what is the percentage of complete and incomplete spinal cord injuries? what is the most common incomplete spinal cord injury?

A
  • 50/50

- central cord

59
Q

what does anterior cord present with?

A
  • mainly motor and LE more than UE; opposite of central cord
60
Q

Odontoid fractures: what is the blood supply? where is the watershed area? what are the risk factors for nonunion?

A
  • carotid artery at the apex and vertebral artery at the base
  • waist
  • age greater than 50, displacement > 6 mm (greatest factor), fracture comminution, posterior angulation, delay to treatment
61
Q

on lateral x-ray 50% subluxation would be ___ facet dislocation while 25% would be ___

A
  • bilateral

- unilateral

62
Q

Lumbar central stenosis: AP diameter of less than ___ and cross sectional area less than ___

A
  • 10

- 100

63
Q

what intra-abdominal injury is associated with pediatric chance fractures?

A
  • colonic rupture
64
Q

what is the area and what specific levels are most commonly affected by OPLL of the spine?

A
  • cervical and C4-6
65
Q

what type of brace should be considered in patients with Schuerrman’s kyphosis and curves between 50 and 75 degrees?

A
  • Charleston extension type brace
66
Q

what is the trajectory of C1 lateral mass screws medial/lateral cephalad/caudal?

A
  • 10 degrees medial and 22 deg cephalad
67
Q

at what level of the lumbar spine does the bifurcation of the aorta occur?

A
  • L4
68
Q

how does the treatment of revision synovial cyst excision differ from a recurrent disk herniation?

A
  • revision + instrumented fusion for synovial cyst
69
Q

C1 Lateral mass screws: what is the danger anteriorly? what is the danger posterior and lateral?

A
  • internal carotid artery

- vertebral artery

70
Q

what is a common urologic complication after ALIF and why?

A
  • retrograde ejaculation due to inflammation to the superior hypogastric plexus
71
Q

what is a common cause of cervical myelopathy in OI patients?

A
  • basilar invagination
72
Q

List factors associated with pre-ganglionic injury

A
  • Horner’s syndrome, loss of paraspinal EMG, normal histamine test, and medial scapular winging

Spine (1 decks)

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