Spine Flashcards
What is the difference between syringomyelia and syringobulbia?
Syringomyelia is spinal cord; syringobulbia is brain stem.
What is the etiology of syringomyelia? (4)
- Cranocervical junction (Chiari malformities);
- spinal cord trauma;
- spinal cord tumors;
- post-infections
What are associated conditions with syringomyelia?
- congenital scoliosis (25-80%);
- Klippel-Feil;
- Charcot joints
What are the indications for an MRI with a patient with scoliosis? (5)
- abnormal curves - double apex (L);
- Neuro deficit/ABN reflexes;
- infantile/juvenile onset;
- Male;
- Kyphosis>30 degrees
Why do we need to identify a syrinx if there is a scoliosis?
Increased risk of neurological deficit if fusion is done with an undiagnosed syrinx.
What are the classifications of spinal cord tumors?
- Intradural - extramedullary;
- Intradural - intramedullary;
- Extradural
What is the most common intradural extramedullary tumor?
Schwannoma
What are the intradural extramedullary tumors?
- Schwannoma;
- Meningioma
Schwannoma is associated with which NF gene?
NF type II
What are 2 risk factors for spinal meningioma?
- NF II;
- Radiation
What is the Tx of spinal meningiona?
If Sx, complete Sx resection, Tx recurrence with radiation therapy
What are the 2 intramedullary intradural tumors?
- Astrocytoma;
- Ependymoma
What is the most common intradural intramedullary CNS tumor?
Ependymoma
How does one differentiate ependymoma from astrocytoma of CNS lesions?
- Astrocytoma - cerviothoracic, eosinophils on histology;
- Ependymoma - usually @ filium terminale, rosettes on hystology
What is the most concerning extradural tumor?
Lymphoma
What is the Tx of extradural lymphoma of the spine?
Chemo with methotrexate
What are 5 indicators of high energy trauma when considering C-spine injuries?
- > 35 mph MVA;
- > 10 feet;
- closed head injuries;
- neurodeficit referrable to C-spine;
- pelvis and extremity #s
What are 4 key history points for C-spine injuries?
- Ank. spond.;
- DISH;
- GLL/Marfans/ED;
- instrumentation/HW
What are 4 complications of late C-spine collar clearance?
- aspiration;
- resp function;
- decubitus ulcers;
- increased ICP
What is the immediate Tx of neurogenic shock?
- Swan-Ganz for fluid monitoring;
- pressors
What are 3 characteristics of spinal shock?
- flaccid paralysis;
- Bradycardia hypotension;
- absent Bulbocavernosis reflex
What are 5 contraindications to high dose methylprednisone?
- GSW;
- pregnancy;
- under 13 yoa;
- > 8 hours post injury;
- Bracial plexus injuries
What are the indications for decompression and stabilization for SCI GSW?
- progressive neurological deficit with retained bullet;
- cauda equina;
- retained bullet fragment within thecal sac (CSF can lead to lead poisoning)
What are the W/C functions of: 1. C3-C4; 2. C5; 3. C6; 4. C7
- C3-C4 - electric W/C with chin controls;
- C5 - electric W/C with hand controls;
- C6 - manual W/C with sliding board transfers;
- C7 - manual W/C with independent transfers