Spine Flashcards
C5
Delt, biceps
lateral shoulder/arm sensation
biceps reflex
C6
bracioradialis, ECRL
thumb sensation
brachioradialis reflex
C7
triceps, FCR
long finger sensation
triceps reflex
C8
FDS
small finger sensation
T1
interossei
medial elbow sensation
L2/L3
iliopsoas, hip adductors
anterior and medial thigh sensation
L4
quad, TA
anterior knee, medial leg sensation
patellar reflex
L5
EHL, TA, TP, hamstrings, glutei
lateral leg, dorsal foot senation
S1
GSC, peroneals
posterior leg sensation
achilles reflex
S2
FHL/FDL
plantar foot sensation
S3/S4
bowel/bladder
perianal sensation
Spinal cord normally extends to…
L2.
Anterior cervical spine approach complications
recurrent laryngeal nerve –> hoarseness
sympathetic nerves –> Horner’s syndrome
ALIF spine approach complications
superior hypogastric plexus –> retrograde ejaculation/infertility
sympathetic trunk –> anhidrosis; one leg feels cold, increased temp of extremity
Lateral LIF spine approach complications
ilioinguinal nerve: travels with round ligament/spermatic cord
iliohypogastric nerve
Which images best show acute SCI?
STIR
Central cord syndrome is usually due to an…
hyperextension injury.
Lateral corticospinal tracts of the upper extremities are more central –> UE more affected than LE.
Anterior cord syndrome
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)
Brown-Sequard
cord hemitransection
- loss of ipsilateral motor and proprioception/vibration
- loss of contralateral pain/temp senesation
After SCI, distended bowel or bladder will stimulate…
autonomic dysreflexia –> HTN, sweating, piloerection, facial flushing, HA, blurred vision, stuffy nose.
Tx: catheterization, disimpaction, treat HTN
What area has highest potential for neuro improvement after SCI?
lumbar (conus medullaris)
ASIA classification
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
The Wiltse approach is between…
the longissimus and multifidus muscles.
Disc herniations will resorb over time via…
phagocytosis by macrophages.
If patient is symptomatic after discectomy, obtain…
MRI w/ gadolinium to differentiate between fibrosis (contrast enhancing) vs recurrent disc herniation (non-enhancing).
Compared to primary discectomy, revision discectomy has…
similar outcomes.
DISH
- associated with DM
- non-marginal syndesmophytes (flowing ossification)
- disc space NOT involved
- most commonly affects right side of thoracic spine
Ankylosis spondylitis
- 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)
Most important atlantoaxial stabilizer
transverse ligament
What indicates disruption of transverse ligament
> 6.9 mm of combined lateral mass overhang (rule of spence)
What is an unstable ADI?
> 3.5 mm in adults
> 5 mm in peds
SAC (or PADI) associated with increased risk of neuro injury
< 13 mm
Treatment of Type I and III odontoid fractures
C-collar
Treatment of type II odontoid
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
Normal C2 osteology
Basilar synchondrosis fuses between 3-6 years of age.
2ndary ossification center fuses at 12 years of age; failure to close –> os odontoideum
Hangman’s fracture
bilateral C2 pars fx –> spondylolisthesis of C2 on C3
*usually non-operative (rigid cervical collar)
Normal facet anatomy
superior facet is anterior to inferior facet
A unilateral facet dislocation will show…
25% listhesis vs bilateral facet dislocation with 50%.
W/ cervical spine facet fx-dislocation, there is highest risk for…
vertebral artery injury.
Halo pin should be placed…
1 cm above the lateral 1/3 of the orbit at the equator of the skull to avoid the supraorbital nerve.
Cranial nerve 6 (abducens nerve)
palsy of lateral rectus –> loss of lateral gaze –> diplopia
Transporting a child on a standard adult backboard will…
flex the neck due to large occiput in children.
Contraindication to posterior only decompression/fusion for cervical spinal stenosis is…
fixed C2-C7 kyphosis > 13 degrees.
Treatment of OPLL w/ adequate cervical lordosis
posterior laminoplasty or laminenctomy w/ fusion (avoid going anteriorly due to high risk of durotomy)
Tx of symptomatic pseudoarthrosis after ACDF
posterior instrumented fusion.
If you suspect recurrent laryngeal nerve palsy after ACDF…
perform direct laryngoscopy to confirm and evaluate extent of injury.
In RA, atlantoaxial subluxation results from…
pannus formationo at the atlantodental joint compromising the transverse ligament.
Indications for posterior C1-2 decompression and fusion in RA
ADI > 10 mm or PADI/SAC < 14 mm
Treatment of basilar invagination w/ cervical myelopathy in RA
posterior occiput-C2 decompression and fusion
lamina fracture is associated with…
traumatic dural tear.
Chance fracture
flexion-distraction injury
**associated with GI injury
**generally unstable and require decompression/stabilization regardless of neuro function
Compression of the cauda equina leads to…
lower motor neuron symptoms.
*Neurogenic bladder –> urinary retention leads to overflow incontinence
**Needs to be decompressed within 48 hours.
Degenerative spondylolisthesis typically occurs at…
L4-L5
Isthmic spondylolisthesis typically occurs at…
L5-S1 (pars defect).
What structure is at risk with reduction of L5-S1 spondylolisthesis
L5 nerve root
Main risk for slip progression is…
age.
What is the greatest risk factor for complication w/ adult deformity surgery?
age > 60
In general, correct the sagittal alignment of adult deformity by…
changing lumbar lordosis.
For back pain, compared to lumbar fusion, cognitive behavioral therapy…
provides equivalent outcomes.
UMN symptoms
spastic paresis, hyperreflexia, babinski
LMN symptoms
flaccid paralysis, hyporeflexia, muscle atrophy, fasciculations
Spondylodiskitis
disc space narrowing and endplate erosion are common with pyogenic osteomyelitis but not with tuberculosis or neoplasm
Best imaging for osteo/epidural abscess
MRI w/ and w/o gadolinium.
Give abx w/o biopsy if positive blood cultures. Otherwise, IR guided biopsy first then abx.
Surgery for osteomyelitis/epidural abscess usually requires…
anterior decompression and fusion +/- posterior instrumented fusion because the infection often involves the vertebral body and disc (anterior structures).
Pott’s disease
spinal tuberculosis
severe focal spinal kyphosis, acid-fast bacilli
Earliest xray finding of pediatric diskitis
loss of lumbar lordosis
