Spine

Question 1

The use of polymethylmethacrylate (PMMA) augmentation at the end vertebra of pedicle screw constructs has been associated with?

Answer 1

• improved correction maintenance
• increased fusion rates
• decreased junctional failure
• increased screw pull-out strength

Question 2

What are 5 provocative tests for cervical radiculopathy?

Answer 2

• Spurling’s test
• shoulder abduction test
• upper limb tension tests
• valsalva maneuver
• neck distraction test

Question 3

Juvenile Idiopathic Scoliosis

What are 6 physical examination findings to look for?

Answer 3

general inspection
* cafe-au-lait spots (neurofibromatosis)
* leg length inequality
* shoulder height differences
* truncal shift
* waist asymmetry and pelvic tilt
* foot deformities (cavovarus)
* can suggest neural axis abnormalities and warrant a MRI

Question 4

Infantile Idiopathic Scoliosis

What are 5 physical examination findings that is important to assess for?

Answer 4

inspection
* cafe-au-lait spots (neurofibromatosis)
* patches of hair
* dimpling over the spinal region
* dimpling outside of the gluteal fold is usually benign
* nevi or other tumors may be indicative of spinal dysraphism
* plagiocephaly (skull flattening)

Question 5

Cervical Radiculopathy

What are three indications for operative management?

Answer 5

• persistent and disabling pain that has failed three months of conservative management
• progressive and significant neurologic deficits
• static neurologic deficit associated with significant radicular pain

Question 6

Cervical Radiculopathy

What are 4 indications for posterior cervical foraminotomy?

Answer 6

• foraminal soft disc herniation causing single level radiculopathy ideal
• may be used in osteophytic foraminal narrowing
• failed nonoperative treatment
• high risk patients with anterior approach
  previous anterior surgery
  abnormal anatomy

Question 7

Thoracolumbar Burst Fractures

What are five instances an anterior decompression and stabilization is preferred for burst fractures?

Answer 7

• neurologic deficits caused by anterior compression (bony retropulsion) , especially above the conus medullaris (above L2)
• allow for thorough decompression of the thecal sac
• substantial vertebral body comminution in order to reconstitute the anterior column
• kyphotic deformity >30°
• chronic injuries
  greater than 4-5 days from the injury

Question 8

Cervical Myelopathy

What are 4 considerations before choosing the appropriate approach and surgical procedure to treat cervical myelopathy?

Answer 8

• cervical alignment
• number of stenotic levels
• location of compression
• medical conditions (e.g., goiter)

Question 9

Cervical Myelopathy

What are 5 possible strategies for surgical management in cervical myelopathy?

Answer 9

treatment procedures include
* anterior cervical diskectomy/corpectomy and fusion
* posterior laminectomy and fusion
* posterior laminoplasty
* combined anterior and posterior procedure
* cervical disk arthroplasty