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Basic Science > Spine > Flashcards

Spine Flashcards

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1
Q

What is the physiologic range of motion of the cervical spine?
Flexion
Extension
Lateral Bending
Bilateral Rotation

A

90 deg flexion
70 deg extension
45 deg lateral
90 bilateral rotation

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2
Q

What are the methods to measure cervical lordosis?

A

Modified Cobb (Endplate of C2 and inferior endplate of C7)
Jackson physiologic stress
Harrison posterior tangent
Ishihara index

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3
Q

A cSVA greater than what is considered abnormal in the cervical spine?

A

50 mm
(distance from a vertical plumb line at C2 to the superior posterior corner of C7)

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4
Q

The angle formed from the inersection of a vertical line and a line between the chin and brown is what?

A

CBVA (normal value is -10 to 20 deg)

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5
Q

A T1 slope minus cervical lordosis of what is considered normal?

A

20 degree

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6
Q

What is the name for a chin to chest deformity?

A

Dropped head syndrome

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7
Q

What is the definition of proximal junctional kyphosis?

A

Increase in more than 10 degrees in the upper instrumented vertebra

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8
Q

An ACDF at a single level can provide what maximum degrees of additional lordosis?

A

3-5 degrees

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9
Q

A Smith Petersen Osteotomy may resuly in appoximately what amount of lordosis?

A

10 degrees

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10
Q

A patient is scheduled for anterior based spine surgery but has a history of a previous anterior cervical spine surgery, what should be assessed?

A

Vocal cord function by way of layngoscopy

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11
Q

What are the complication rates and revision rates for the surgical treatment of cervical spine deformity?

A

20% for complications and 12% for revision

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12
Q

What are the risk factors for distal junctional kyphosis after cervical deformity correction?

A

Severe preoperative cervical deformity (cSVA), T1S-cervical lordosis, and thoracic kyphosis

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13
Q

Degenerative spondylolisthesis of cervical spine is found where?

A

C3-C4

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14
Q

What is the most common adverse postoperative complication of laminoplasty for multilevel cervical spondylotic myelopathy?

A

Loss of cervical range of motion

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15
Q

What structure is most at risk with anterior penetration of C1 lateral mass screws?

A

Internal carotid artery

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16
Q

Isthmic spondylolisthesis most often occurs at what level?

A

L5/S1

5% of population, especially innuits and young males in repetitive hyperextension activities

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17
Q

What is defined as 100% translation of one vertebra over the next caudal vertebra?

A

Spondyloptosis

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18
Q

Why are isthmic slips more prone to progression at L4/5 instead of L5/S1?

A

Because the iliolumbar ligament adds stability to L5/S1

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19
Q

What spinal measurement parameter means increased loaging on the L5 pars articularis?

A

High pelvic incidence and high sacral slope

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20
Q

True or False: Spondylolisthesis is believed to be related to an autosomal dominant genetic predisposition with incomplete penetrance

A

True

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21
Q

When is pars repair indicated in isthmic spondylosis?

A

Persistent symptoms, minimal degenerative disk disease, no slippage, no discogenic component to pain

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22
Q

For adult isthmic spondylosis, evidence supports higher fusion rates with use of anterior column support for what grades?

A

Grades 3-4, NOT grades 1-2

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23
Q

What cervical level is most common for degenerative spondylolisthesis?

A

C3-C4

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24
Q

What percentage of anterior iliac crest graft patients have chronic hip pain?

A

0.25%

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25
Q

What are the risk factors for airway compromise after anterior cervical surgery?

A

Surgery greater than 5 hours
More than 4 levels

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26
Q

Autologous bone graft, bone marrow aspirate, are examples of what kind of bone graft?

A

Osteogenic (Have live cells)

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27
Q

True or False: Biomechanical studies have demonstrated compressive and tensile strength similar to that of frozen allograft but reduced torsional/bending strength compared with fresh or fresh-frozen bone because of the drying process

A

True

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28
Q

What BMP was FDA approved in 2002 for use in ALIFs?

A

BMP-2 for grade-1 spondylolisthesis and degenerative disease
(Also approved for tibial nonunion in 2004)

29
Q

Bioelectric potential is electro-what in areas of compression?

A

Eletronegative

30
Q

What Type of Adult Scoliosis is attributed to primary degenerative changes?

A

Type 1
(Type 2 is progression of AIS and Type 3 is secondary to something else)

31
Q

What defines osteoporosis?

A

T-score less than –2.5 or an osteoporotic fracture

32
Q

Sagittal realignment targets have been suggested, including a SVA less than (1) mm, pelvic tilt less than (2)°, lumbar lordosis = pelvic incidence ± (3)°, and T1 SPI less than (5)

A

SVA < 50 mm
PT < 20
LL - PI = 9
Less than 0

33
Q

What are the levels we want for deformity surgery optimization:
BMI
Albumin
A1C
Hemoglobin
Vitamin D (25OHD)
DEXA
Morphine Equivalents

A

BMI < 35
Albumin > 3.5 g/dL
A1C < 7%
12 for men and 13 for women
Vitamin D > 30 ng/mL (if low, initiate 50,000 weekly)
DEXA > -2.5
Morphine <10 mg/d

34
Q

In spine surgery, what does cross-links increase?

A

rotational stability and strength

35
Q

With correction of spinal deformity, what level has the greatest incidence of psuedoarthrosis?

A

L5-S1

36
Q

Most major and minor complications of ASD surgery occur when?

A

Less than 3 months postoperatively or 2 years (PJK and implant failure)

Increased risk with obesity, ASA, 3 column osteotomy, correction of kyphosis

Complication rate at 55%

37
Q

By age 65, what percentage of men and women will have degenerative spine changes?

A

95% of men and 70% of women

38
Q

Cervical disc disease most commonly involves what level?

A

C5-C6

39
Q

On cervical spine XRs, what is the normal distance expected from the back of the posterior body to the spinolaminar line?

A

14 mm or more

40
Q

What composes pavlov’s ratio for the cervical spine?

A

canal / vertebral body width

41
Q

The facet is innervated by what?

A

Medial branch and dorsal primary rami of the sinuvertebral nerve

42
Q

What are the waddell signs?

A

Tenderness to light touch
Pain in nonanatomic
Loss of findings during distraction
Overreaction
Pain on axial head loading

43
Q

What are two significant risk factors for airway complications after an ACDF?

A

OR Time Greater than 5 hours

Exposure of 4 or more vertebral bodies

44
Q

For SSEP, what are considered significant changes?

A

50% amplitude
10% latency

45
Q

What disc pathology is a contraindication to posterior keyhole laminoforaminotomy?

A

Central disc herniation

46
Q

What is the first stage of cervical spine involvement in RA patients?

A

Atlas Axis subluxation (50-80%)
-Pannus formation at synovial joints

47
Q

Instability at C1/C2 is suggested by ADI motion of more than what in flexion and extension?

A

3.5 mm

48
Q

What is a hypothetical line drawn between the hard palate and the most caudal point of the occipital curve. When the odontoid tip is > 4.5 mm above this line, then basilar invagination is considered

A

Mcgregors line

49
Q

What is the Magerl fixation?

A

C1-C2 transarticular screw fixation

Requires reduction of C1/C2 joint

50
Q

What is the harms construct?

A

C1 lateral mass screws and C2 pedicle/pars fixation

-Biomechanically strongest construct of C1-C2
-Does not require reduction of C1/C2 joint

51
Q

Cervicomedullary angle of what suggests impending neurologic impairment?

A

Less than 135 degrees

52
Q

OPLL is commonly seen in what patient population?

A

Asian and Men

53
Q

An anterior cervical plate for a ACDF move center of rotation where?

A

Anteriorly

54
Q

Name of the 6 types of spondylolisthesis

A

Dysplastic
Isthmic
Degenerative
Iatrogenic
Pathologic
Traumatic

55
Q

What is the general indication for repair of a pars defect?

A

Younger patients with slippage less than 10% and a pars defect that is at L4 or above

56
Q

According to the SPORT trial, how did operative treatment of degenerative spondylolisthesis compare to conservative treatment?

A

At 4 years, operative was better for primary outcome measures (SF-36, ODI)

57
Q

What are the cephalad and medial degrees for a C1 lateral mass screw?

A

22 degrees cephalad, 10 degrees medial

58
Q

What percentage of patients with isthmic spondylosis will progress to spondylolisthesis?

A

15%

59
Q

In cauda equina, what symptom if present is least likely to improve?

A

Bladder dysfunction

60
Q

What is the most common complication after a PSO?

A

Pseudoarthrosis (29%)

61
Q

What direction of thoracic curve should plan for an MRI?

A

Left curving thoracic curve

62
Q

Degrees of correction with ponte/smith peterson?

A

5-10 degrees

63
Q

What uses low volume, high pressure, low viscosity for vertebral body fractures?

A

Vertebroplasty (does not allow correction) “vertebra focuses on vertebra”

64
Q

Name three tumors of spine posterior elements:

A

ABC, osteoid osteome, osteoblastoma

65
Q

Jailhouse striations on xray of the spine indicate what?

A

Hemangioma

66
Q

What is the most common symptom with cauda equina?

A

Back and leg pain

67
Q

The MRI finding most consistent with a complete spinal cord injury is what found in the cord?

A

Hematoma

68
Q

What is the most important risk factor for complications for deformity surgery?

A

Older age

69
Q
A

Basic Science (10 decks)

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