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OITE Review Book > Spine > Flashcards

Spine Flashcards

1
Q

C5

A

Delt, biceps

lateral shoulder/arm sensation

biceps reflex

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2
Q

C6

A

bracioradialis, ECRL

thumb sensation

brachioradialis reflex

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3
Q

C7

A

triceps, FCR

long finger sensation

triceps reflex

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4
Q

C8

A

FDS

small finger sensation

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5
Q

T1

A

interossei

medial elbow sensation

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6
Q

L2/L3

A

iliopsoas, hip adductors

anterior and medial thigh sensation

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7
Q

L4

A

quad, TA

anterior knee, medial leg sensation

patellar reflex

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8
Q

L5

A

EHL, TA, TP, hamstrings, glutei

lateral leg, dorsal foot senation

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9
Q

S1

A

GSC, peroneals

posterior leg sensation

achilles reflex

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10
Q

S2

A

FHL/FDL

plantar foot sensation

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11
Q

S3/S4

A

bowel/bladder

perianal sensation

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12
Q

Spinal cord normally extends to…

A

L2.

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13
Q

Anterior cervical spine approach complications

A

recurrent laryngeal nerve –> hoarseness

sympathetic nerves –> Horner’s syndrome

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14
Q

ALIF spine approach complications

A

superior hypogastric plexus –> retrograde ejaculation/infertility

sympathetic trunk –> anhidrosis; one leg feels cold, increased temp of extremity

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15
Q

Lateral LIF spine approach complications

A

ilioinguinal nerve: travels with round ligament/spermatic cord

iliohypogastric nerve

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16
Q

Which images best show acute SCI?

A

STIR

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17
Q

Central cord syndrome is usually due to an…

A

hyperextension injury.

Lateral corticospinal tracts of the upper extremities are more central –> UE more affected than LE.

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18
Q

Anterior cord syndrome

A

Injury to anterior spinal artery which supplies anterior 2/3 of cord.

-loss of motor (corticospinal tract) & pain/temp sensation (spinothalamic tract) but preserved proprioception/vibration (dorsal columns)

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19
Q

Brown-Sequard

A

cord hemitransection

  • loss of ipsilateral motor and proprioception/vibration
  • loss of contralateral pain/temp senesation
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20
Q

After SCI, distended bowel or bladder will stimulate…

A

autonomic dysreflexia –> HTN, sweating, piloerection, facial flushing, HA, blurred vision, stuffy nose.

Tx: catheterization, disimpaction, treat HTN

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21
Q

What area has highest potential for neuro improvement after SCI?

A

lumbar (conus medullaris)

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22
Q

ASIA classification

A

Grade A: complete; no motor or sensory below level
Grade B: incomplete; sensory preserved, no motor
Grade C: incomplete; more than half the muscles involved have grade < 3 strength
Grade D: more than half the muscles involved have >/= 3 strength
Grade E: normal

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23
Q

The Wiltse approach is between…

A

the longissimus and multifidus muscles.

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24
Q

Disc herniations will resorb over time via…

A

phagocytosis by macrophages.

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25
Q

If patient is symptomatic after discectomy, obtain…

A

MRI w/ gadolinium to differentiate between fibrosis (contrast enhancing) vs recurrent disc herniation (non-enhancing).

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26
Q

Compared to primary discectomy, revision discectomy has…

A

similar outcomes.

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27
Q

DISH

A
  • associated with DM
  • non-marginal syndesmophytes (flowing ossification)
  • disc space NOT involved
  • most commonly affects right side of thoracic spine
28
Q

Ankylosis spondylitis

A
  • HLA-B27
  • sacroiliitis and enthesitis
  • marginal syndesmophytes
  • vertebral scalloping
  • disc space ossified
  • kyphotic deformity (chin on chest) –> tx w/ C7-T1 posterior osteotomy/fusion

***THA w/ AS is at increased risk of anterior dislocation bc of relative hyperextension of the hip (even after posterior approach)

29
Q

Most important atlantoaxial stabilizer

A

transverse ligament

30
Q

What indicates disruption of transverse ligament

A

> 6.9 mm of combined lateral mass overhang (rule of spence)

31
Q

What is an unstable ADI?

A

> 3.5 mm in adults

> 5 mm in peds

32
Q

SAC (or PADI) associated with increased risk of neuro injury

A

< 13 mm

33
Q

Treatment of Type I and III odontoid fractures

A

C-collar

34
Q

Treatment of type II odontoid

A

young pt, small displacement: c-collar

old pt, large displacement: posterior C1-2 fusion

**aberrant vertebral artery is a contraindication to C1-2 transarticular screws

35
Q

Normal C2 osteology

A

Basilar synchondrosis fuses between 3-6 years of age.

2ndary ossification center fuses at 12 years of age; failure to close –> os odontoideum

36
Q

Hangman’s fracture

A

bilateral C2 pars fx –> spondylolisthesis of C2 on C3

*usually non-operative (rigid cervical collar)

37
Q

Normal facet anatomy

A

superior facet is anterior to inferior facet

38
Q

A unilateral facet dislocation will show…

A

25% listhesis vs bilateral facet dislocation with 50%.

39
Q

W/ cervical spine facet fx-dislocation, there is highest risk for…

A

vertebral artery injury.

40
Q

Halo pin should be placed…

A

1 cm above the lateral 1/3 of the orbit at the equator of the skull to avoid the supraorbital nerve.

41
Q

Cranial nerve 6 (abducens nerve)

A

palsy of lateral rectus –> loss of lateral gaze –> diplopia

42
Q

Transporting a child on a standard adult backboard will…

A

flex the neck due to large occiput in children.

43
Q

Contraindication to posterior only decompression/fusion for cervical spinal stenosis is…

A

fixed C2-C7 kyphosis > 13 degrees.

44
Q

Treatment of OPLL w/ adequate cervical lordosis

A

posterior laminoplasty or laminenctomy w/ fusion (avoid going anteriorly due to high risk of durotomy)

45
Q

Tx of symptomatic pseudoarthrosis after ACDF

A

posterior instrumented fusion.

46
Q

If you suspect recurrent laryngeal nerve palsy after ACDF…

A

perform direct laryngoscopy to confirm and evaluate extent of injury.

47
Q

In RA, atlantoaxial subluxation results from…

A

pannus formationo at the atlantodental joint compromising the transverse ligament.

48
Q

Indications for posterior C1-2 decompression and fusion in RA

A

ADI > 10 mm or PADI/SAC < 14 mm

49
Q

Treatment of basilar invagination w/ cervical myelopathy in RA

A

posterior occiput-C2 decompression and fusion

50
Q

lamina fracture is associated with…

A

traumatic dural tear.

51
Q

Chance fracture

A

flexion-distraction injury

**associated with GI injury

**generally unstable and require decompression/stabilization regardless of neuro function

52
Q

Compression of the cauda equina leads to…

A

lower motor neuron symptoms.

*Neurogenic bladder –> urinary retention leads to overflow incontinence

**Needs to be decompressed within 48 hours.

53
Q

Degenerative spondylolisthesis typically occurs at…

A

L4-L5

54
Q

Isthmic spondylolisthesis typically occurs at…

A

L5-S1 (pars defect).

55
Q

What structure is at risk with reduction of L5-S1 spondylolisthesis

A

L5 nerve root

56
Q

Main risk for slip progression is…

A

age.

57
Q

What is the greatest risk factor for complication w/ adult deformity surgery?

A

age > 60

58
Q

In general, correct the sagittal alignment of adult deformity by…

A

changing lumbar lordosis.

59
Q

For back pain, compared to lumbar fusion, cognitive behavioral therapy…

A

provides equivalent outcomes.

60
Q

UMN symptoms

A

spastic paresis, hyperreflexia, babinski

61
Q

LMN symptoms

A

flaccid paralysis, hyporeflexia, muscle atrophy, fasciculations

62
Q

Spondylodiskitis

A

disc space narrowing and endplate erosion are common with pyogenic osteomyelitis but not with tuberculosis or neoplasm

63
Q

Best imaging for osteo/epidural abscess

A

MRI w/ and w/o gadolinium.

Give abx w/o biopsy if positive blood cultures. Otherwise, IR guided biopsy first then abx.

64
Q

Surgery for osteomyelitis/epidural abscess usually requires…

A

anterior decompression and fusion +/- posterior instrumented fusion because the infection often involves the vertebral body and disc (anterior structures).

65
Q

Pott’s disease

A

spinal tuberculosis

severe focal spinal kyphosis, acid-fast bacilli

66
Q

Earliest xray finding of pediatric diskitis

A

loss of lumbar lordosis

OITE Review Book (10 decks)

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