Razi Trauma Review

Question 1

Define instability:

Answer 1

• translation of 3.5mm (or 20%)
• angulation >10 degrees
• direct MRI visualization of a disrupted discoligamentous complex (PLC/DLC)

Question 2

What did STASCIS study show:

Answer 2

decompression within 24 hours is safe and is a predictor of improved neurologic outcome
- includes central cord syndrome

Question 3

SLIC Classification

Answer 3

• morphology
• discoligamentous copmlex
• neurological status

score >5 requires surgery

Question 4

Timing to closed reduction of facet dislocations:

Answer 4

• within 1-3 hours if you have neurologic defecits

Question 5

Clay Shoveler Fracture

Answer 5

spinous process avulsion

Question 6

Sentinel fracture

Answer 6

laminar fx on either side of the SP

Question 7

Vertebral artery injuries

Answer 7

occur in 11% of c-spine injuries most commonly with lateral mass fracture

Question 8

Hangman is:

Answer 8

bilateral C2 pars fracture

Question 9

Pseudosubluxation:

Answer 9

C3-4 in kids under age 4

due to horizontal facets

Question 10

C2 fx, type 2, greater than 5mm displacement requires:

Answer 10

fusion

if <5mm they can have a halo

Question 11

parameters for halo placement

Answer 11

• 4 pins, 8lb
• ## peds = more pins, less lbs

Question 12

non op treatment for type 3 dens fx is:

Answer 12

hard collar

Question 13

AAOS guidelines for compression fx:

Answer 13

• give calcitonin within 4 days
• bracing is not indicated, other than for comfort…
• vertebroplasty is never indicated (According to guidelines)
• kyphoplasty (if still painful after 6 weeks of non-op… the indication is persistent pain)
• L2 nerve root block is indicated for L3 of L4 injuries

Question 14

when do you do surgery for burst fracture:

Answer 14

50% canal compromise

OR 10 degrees angulation

Question 15

treatment for chance fracture:

Answer 15

bony chance = non op

ligamentous = op

Question 16

associated injuries with chance fracture

Answer 16

visceral injuries

• mesenteric artery rupture
• sigmoid colon

Question 17

fusion levels for TL injuries?

Answer 17

3 above and 2 below

Question 18

TLICS score for surgery?

Answer 18

5 or greater

Question 19

where do the iliac vessels bifurcate

Answer 19

L4-5 and body of L5

Question 20

lumbar total disc at 2 years has:

Answer 20

better patient satisfaction than fusion

no difference in revision or complication

Question 21

SPORT:

Answer 21

improvement in primary and secondary outcomes with surgery compared with non-op at 4 years, 8 years

best improvement with:

• back pain
• upper lumbar HNP
• married
• worsening pain

at 8 years, 85% of reop due to recurrent HNP

Question 22

steroid dose

Answer 22

30mg/kg loading for first hour, then 5mg/kg/hr x23 hours if given within 3 hours (or x47 hours if given >3 hours)

Question 23

if you see a facet cyst it suggests:

Answer 23

instability

• get flex/ex
• may be more likely to require fusion

Question 24

what is hanging curtain sign

Answer 24

the psoas moves upward from a spinal abscess - it is draped over the abscess

Question 25

anytime you do a decompression for infection in the thoracic spine what do you do:

Answer 25

• need to fuse them because of the thoracic kyphosis

- if you do lami, with the loss of disc and bone, you are high risk for progressive kyphosis

Question 26

hemangiomas on MRI are:

Answer 26

bright on T1 and T2

Question 27

most common root in a degen spndy?

Answer 27

L5

Question 28

isthmic spondy most commonly occurs at:

Answer 28

L5 (fuse L5-S1 if unremitting)

Question 29

in situ fusion is:

Answer 29

posterolateral fusion without instrumentation, with bone grafting

Question 30

retrograde ejaculation from:

Answer 30

superior hypogastric plexus injury

Question 31

pediatric rotatory subluxation treatment

Answer 31

if chronic, needs C1-2 fusion
if <1 week, do soft collar and nsaids
if  >1 week is head halter traction and muscle relaxants
>1 month is halo traction
>6 months is fusion

most common cause is Grisel’s syndrome (URI)
dx on xrays and dynamic CT scan
fails to resolve with attempts to correct the torticollis

Question 32

C spine issue in OI

Answer 32

basilar invagination

Question 33

C spine issue in Morquio

Answer 33

AA instability