Razi Review Facts Flashcards
The SPORT trial for Lumbar Disc Herniations Shows:
improved treatment effect of surgery if:
- age >41 years
- no history of joint problems
- high school education or less
- no worker’s comp
- pain for >6 months
- being married
- pain trend worsening
- mental component score < 35
Outcomes of revision lumbar discectomy compared with primary lumbar disc surgery?
similar outcomes with respect to pain and function (using VAS and ODI)
Patel BJJ 2013 23307679
BIochemistry of degenerating discs:
- decreased H2O
- decreased proteoglycans
- decreased chondroitin sulfate
- decreased pH
- decreased cellularity
- increased keratin sulfate
- increased degradative enzymes
- increased lactate levels
Meta-analysis of the Cauda Equina Syndrome secondary to lumbar disc herniation Outcomes Demonstrates what:
- surgery within 24-48 hours is best for recovery
- surgery beyond 48 hours has worst function (no diffrence between 50 hours and 1 month)
- ## pre-op back pain associated with worse recovery
C8 nerve root signature is:
- sensory on medial forearm and hand (5th digit)
- weakness in long flexor function in all digits + thumb
- would present similar to an ulnar neuropathy
- to distinguish, check DFP of the IF and MF (should function in ulnar neuropathy, should malfuction in C8 radic)
- also sensation would be present on medial forearm in ulnar neuropathy (MABC nerve)
Should you operate on a patient with a stable burst fracture and no neurologic deficit?
controversial, but…
literature says surgery has no benefit and increases complications.
the meta-analyses show that early and late function is no different if you treat non-op.
Rates of improvement in ASIA A from thoracic or thoraclumbar SCI?
4% over a 10 year period
Harrop, Spine 2011 21192220
Advantages of doing extension osteotomy for AS at the C7-T1 junction?
- vertebral vessels are anterior to the spine
- C8 root tolerates migration better than more cranial roots
- spinal canal is wider at that area
Central cord syndrome:
motor deficits upper >lower
wrist/fingers > than shoulders
therefore, can expect regain ambulation capacity, but may not regain hand function
Factors predicting regain of function after central cord syndrome?
ASIA motor scores tend to increase. Improved if:
- initial motor score
- formal education
- comorbidities
- age at injury
- development of spasiticity
What is the cervical kyphosis angle that portends poor outcomes in cervical laminoplasty?
13 degrees
What is the incidence of C5 palsy following cervical laminoplasty?
5%
Medial placement of the anterior pins of a halo can hit what nerve?
supraorbital and supratrochlear (most medial)
- put it 1cm above the orbital rim, along the outer 2/3 of the orbit
- the halo should pass about 1cm above the helix of the ear
Most common complications of halo immobliization?
pin loosening 36%
pin-site infection 20%
pressure sores under a vest 11%
nerve injury 2%
dural penetration 1%
scars in 9%
DDx of cervical radiculopathy includes:
- peripheral nerve entrapment
- brachial plexus injury
- PArsonage-Turner
- tendinopathy of the upper extremity
