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Huang's Orthopaedic Surgery > Spine > Flashcards

Spine Flashcards

1
Q

What is the classification system of odontoid fractures?

A

Anderson & D’Alonzo
Type 1: Oblique avulsion fracture of the tip of the odontoid due to alar ligament avulsion. Generally stable but check with flex/ex views
Type 2: Fracture through waist of odontoid. High non-union rate due to interruption of blood supply
Type 3: Fracture extends into the cancellous body of C2 and variably includes the C1-2 joint

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2
Q

What is an os odontoideum?

A

Now thought to be an old traumatic process of the odontoid. Observe

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3
Q

What is the management for type 2 odontoid fractures?

A 
Young: 
- Halo if no risk factors for nonunion
- Surgery if risk factors for nonunion
Elderly:
- Cervical Orthosis if not surgical candidates
- Surgery if surgical candidates
- No halo - high morbidity and mortality
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4
Q

In the elderly population, what form of management has the highest rate of morbidity/mortality for odontoid fractures?

A

Halo vest immobilization

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5
Q

What level has the smallest pedicle diameter? Second smallest?

A

T4

L1

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6
Q

What pathway is damaged in central cord syndrome?

A

Lateral corticospinal tract

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7
Q

Describe the ASIA scale:

A

A=Awful, E=Excellent
ASIA A: Complete. No motor or sensory
ASIA B: Incomplete. No motor function but some remaining sensory
ASIA C: Incomplete. 50% or more of muscles below injury are less than Grade 3.
ASIA D: Incomplete. 50% or more of muscles below injury are greater than or equal to than Grade 3.
ASIA E: Normal

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8
Q

What is the most common nerve palsy associated with Halo vest application?

A

CN VI palsy

- Lateral rectus deficiency: Deficient lateral eye movement

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9
Q

What is the safe zone for anterior pin placement of a halo?

A

Approximately 1-cm region just above the lateral one third of the orbit (eyebrow) at or below the equator of the skull.

  • Lateral pin insertion risks penetration of the thin temporal bone.
  • Medial positioning risks injury to the supraorbital and supratrochlear nerves
  • An injury to the supraorbital nerve may lead to pain and numbness over the medial one third of the eyebrow. The supratrochlear nerve supplies sensation medial and inferior to the supraorbital sensory distribution
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10
Q

What is a PLIF? TLIF?

A

PLIF: Posterior lumbar interbody fusion
TLIF: Transforaminal lumbar interbody fusion

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11
Q

What are the risk factors for discitis/vertebral osteomyelitis?

A

Diabetes

IVDU

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12
Q

What is the treatment of discitis/vertebral osteomyelitis?

A

Must determine organism either by blood cultures or biopsy.
Appropriate abx for no neurological comproise
Surgical management for those with progressive neurological compromise

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13
Q

What is the percentage risk of infection in lumbar discectomy with and without microscope?

A
  1. 7% without

1. 4% with microscope (so it’s higher with microscope)

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14
Q

While controversial, what is an accepted indication and dose of methylprednisolone treatment?

A

Acute SCI presenting within 3hrs of injury

Dose: 30mg/kg bolus followed by 5.4mg/kg/hr x24hrs

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15
Q

What is an absolute contraindication to C1-C2 transarticular screws?

A

Aberrant vertebral artery

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16
Q

What is the normal course of the vertebral artery?

A

Runs from C2-C6

On C1, it wraps around the posterior arch on the medial side before going into the foramen magnum

17
Q

What is the incidence of major complications in adult spinal surgery?

A

10-20%

18
Q

What is cervical myelopathy?

A

Clinical syndrome characterized by:
- Clumsiness of the hands
- Gait imbalance
Caused by compression of the cervical spinal cord

19
Q

What are the causes of cervical myeopathy?

A
  • Degenerative cervical spondylosis (CSM)
  • Degenerative changes (osteophytes, discosteophyte complex)
  • Degenerative spondylolithesis
  • OPLL
  • Tumor
  • Epidural abscess
  • Trauma
  • Cervical kyphosis
20
Q

What is a Hangman’s fractures?

A 
Traumatic anterolisthesis of C2, with fracture through pars
Hyperextension injury (commonly from MVC)
21
Q

Describe the classification of Hangman’s fracture (traumatic spondylolisthesis)

A

Levine & Edwards classification
Type I: 3mm displacement. Vertical fracture line. 5mm displaced then surgery. Will heal regardless (autofuse)
Type IIb: Horizontal fracture line with no displacement; significant angulation. AVOID traction. Req hyperextension for reduction then Halo
Type III: Type I with bilateral facet dislocation. Surgical reduction

22
Q

What is a plough fracture?

A

Isolated anterior or posterior arch fracture of C1

23
Q

What is a Jefferson fracture?

A

Fracture of anterior & posterior arches of C1. Essentially a burst fracture of C1

24
Q

In C1 fractures, what is stability determined by?

A

Integrity of the transverse ligament

Huang's Orthopaedic Surgery (15 decks)

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