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ABOS Part 1 > Spine > Flashcards

Spine Flashcards

1
Q

Cervical levels based on regional landmark anatomy?

A

C2-3: angle of mandible
C3-4: hyoid bone
C4-5: thyroid cartilage
C5-6: cricoid cartilage

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2
Q

The majority of lumbar lordosis is located at these levels?

A

L4-S1

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3
Q

MEP monitoring threshold in OR?

A

>75% decrease in MEP amplitude that is sustained

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4
Q

SSEP monitoring threshold in OR?

A

>10% signal latency
>50% decrease in amplitude

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5
Q

Congenital cervical stenosis definition

A

<10 mm space available for spinal cord and meet surgical indication for decompression.

<8 mm is absolute, and requires operative decompression in more urgent basis

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6
Q

How to best evaluate OPLL?

A

CT scan

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7
Q

Myelomalacia vs cord edema on MRI?

A

Myelomalacia there is cord signal on both T1 and T2.

Cord edema only T2.

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8
Q

Cutoff for the Japanese orthopedic association (JOA) prognostic predictor?

A

>14 monitor

Below 14 means high risk, patient should be indicated for surgery.

JOA 4 or less means wheelchair bound

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9
Q

What to do if patient has lumbar spinal stenosis with myelopathic features?

A

Order cervical MRI

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10
Q

Indicators of poor outcome for cervical myelopathy?

A

***JOA <14
Snake eyes myelomalacia
Older age
Smoking
Space available for cord
Transverse area >70 mm = better
<13 mm mid Sagittal diameter = worse

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11
Q

Surgical algorithm for cervical myelopathy

A

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12
Q

For cervical myelopathy caused by OPLL, the preferred this approach?

A

Posterior because high risk of dural tear if going anterior. Only anterior if >10 deg kyphosis

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13
Q

Cord concussion / transient quadriplegia return to play guidelines?

A

- full resolution of symptoms
- normal strength and sensation
- normal MRI

*must rule out congenital cervical stenosis

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14
Q

Cervical pathology in RA?

A

1. Basilar invagination
2. Atlantoaxial subluxation
3. Subaxial subluxation (spondylolisthesis at multiple levels, “stair step deformity”)

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15
Q

Why do RA patients have antlantoaxial subluxation?

A

The pannus between the dens and C1 causes destruction of the transverse ligament

Measure ADI and PADI for surgical decision making (PADI more important)

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16
Q

Atlantoaxial subluxation in RA patient, what are surgical indications?

A

ADI >10

PADI <14

Treatment is C1-C2 fusion

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17
Q

Collagen in annulus fibrosis?

A

Type 1

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18
Q

Collagen in nucleus pulposis?

A

Type 2

19
Q

Common palsy after cervical spine surgery?

A

C5

Observation is treatment

20
Q

Hypoglossal nerve injury can occur with this approach?

A

High cervical anterior approach (c2-3, c3-4)

Tongue deviates toward side of injury

21
Q

Forces head/neck extension results in this cord syndrome? Generally in elderly.

A

Central cord syndrome

Greater motor deficits in upper extremities than lower extremities

Treatment:
- nonop: symptoms improving, no pre-existing myelopathy
-operate: existing severe stenosis, worsening symptoms, pre-existing symptomatic myelopathy

22
Q

Anterior spinal cord injury/ anterior cord syndrome?

A

Usually after vascular procedure where the vasculature to the anterior spinal artery is disrupted.

Worse lower extremity function than upper. Loss of pain and temp.

Put in ICU and push MAPs, no surgical intervention indicated

23
Q

Brown-sequard syndrome

A

Loss of ipsilateral motor and proprioception.
Loss contralateral pain and temp.

High rate of recovery

24
Q

In addition to surgically stabilizing the spine in DISH and ankylosing spondylitis trauma what else needs to be done and why?

A

Decompression due to high rates of compressive epidural bleeds.

25
Q

Additional risk factors for nonunion for type 2 odontoid fractures?

A

>50 yo
>6mm displacement
>10 deg post angulation
Comminution
Treatment delay
Diabetes

26
Q

Cervical neck trauma and lateral XR demonstrate 25% vertebral body subluxation, what injury are you concerned for?

A

Unilateral facet dislocation

>25% subluxation then concern for bilateral facet dislocation

27
Q

Cervical facet dislocation algorithm

A

Always get MRI before surgery
Posterior if unable to close reduce
Anterior if neurologic symptoms/disc extrusion

*note: associated with vertebral artery injuries, thus get CT or MR angio

28
Q

Safe zone for halo pins?

A

Lateral 1/3 of orbit
(Risk of injuring abducens nerve CNVI which would cause inability to maintain lateral gaze)

29
Q

RA patients should have this done prior to intubation surgical procedures?

A

Flexion and extension radiographs to assess for Atlantoaxial instability

30
Q

Vocal cord position when recurrent laryngeal nerve injured?

A

Vocal cord ADDucted

31
Q

Anterior ACDF confer in singer?

A

Injury to superior laryngeal nerve which could cause loss of high phonation

32
Q

Anatomy of vertebral artery and cervical nerve root?

A

33
Q

Vertebral osteomyelitis is most commonly found in this region of the spine?

A

Lumbar

34
Q

Osteotomy used to correct Sagittal balance irregularities from prior fusions?

A

Pedicle subtraction osteotomies

35
Q

Differences between AS and DISH

A

36
Q

Threshold for pedicle breach?

A

>8 milliamps indicates intact pedicle

37
Q

Most common location of artery of adamcawicz?

A

Left T9-L1

38
Q

ADI criteria for surgery?

A

ADI >10

39
Q

PADI criteria for surgery for Atlantoaxial subluxation?

A

<14

40
Q

Cervical Subaxial subluxation criteria for surgery in RA?

A

Subluxation >4 mm
More accurately, when spinal canal diameter <13 mm

41
Q

Level of transoas approach with highest risk to the femoral nerve?

A

L4-5

42
Q

Goal parameters after corrective surgery for adult spinal deformity?

A

1. TK + LL + PI = <45 deg
2. PI=LL, PT <25 deg, SVA <5cm
3. T1 pelvic angle <14 deg

GAP score <3

43
Q

Torg ratio… what it is and how to measure it?

A

Measure of congenital stenosis in the cervical spine.

Diameter of spinal canal / diameter of vertebral body. Values less than 0.8 meet criteria for congenital spinal stenosis

ABOS Part 1 (11 decks)

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