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Spine Flashcards

1
Q

What is the difference between syringomyelia and syringobulbia?

A

Syringomyelia is spinal cord; syringobulbia is brain stem.

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2
Q

What is the etiology of syringomyelia? (4)

A
  1. Cranocervical junction (Chiari malformities);
  2. spinal cord trauma;
  3. spinal cord tumors;
  4. post-infections
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3
Q

What are associated conditions with syringomyelia?

A
  1. congenital scoliosis (25-80%);
  2. Klippel-Feil;
  3. Charcot joints
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4
Q

What are the indications for an MRI with a patient with scoliosis? (5)

A
  1. abnormal curves - double apex (L);
  2. Neuro deficit/ABN reflexes;
  3. infantile/juvenile onset;
  4. Male;
  5. Kyphosis>30 degrees
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5
Q

Why do we need to identify a syrinx if there is a scoliosis?

A

Increased risk of neurological deficit if fusion is done with an undiagnosed syrinx.

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6
Q

What are the classifications of spinal cord tumors?

A
  1. Intradural - extramedullary;
  2. Intradural - intramedullary;
  3. Extradural
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7
Q

What is the most common intradural extramedullary tumor?

A

Schwannoma

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8
Q

What are the intradural extramedullary tumors?

A
  1. Schwannoma;
  2. Meningioma
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9
Q

Schwannoma is associated with which NF gene?

A

NF type II

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10
Q

What are 2 risk factors for spinal meningioma?

A
  1. NF II;
  2. Radiation
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11
Q

What is the Tx of spinal meningiona?

A

If Sx, complete Sx resection, Tx recurrence with radiation therapy

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12
Q

What are the 2 intramedullary intradural tumors?

A
  1. Astrocytoma;
  2. Ependymoma
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13
Q

What is the most common intradural intramedullary CNS tumor?

A

Ependymoma

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14
Q

How does one differentiate ependymoma from astrocytoma of CNS lesions?

A
  1. Astrocytoma - cerviothoracic, eosinophils on histology;
  2. Ependymoma - usually @ filium terminale, rosettes on hystology
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15
Q

What is the most concerning extradural tumor?

A

Lymphoma

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16
Q

What is the Tx of extradural lymphoma of the spine?

A

Chemo with methotrexate

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17
Q

What are 5 indicators of high energy trauma when considering C-spine injuries?

A
  1. > 35 mph MVA;
  2. > 10 feet;
  3. closed head injuries;
  4. neurodeficit referrable to C-spine;
  5. pelvis and extremity #s
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18
Q

What are 4 key history points for C-spine injuries?

A
  1. Ank. spond.;
  2. DISH;
  3. GLL/Marfans/ED;
  4. instrumentation/HW
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19
Q

What are 4 complications of late C-spine collar clearance?

A
  1. aspiration;
  2. resp function;
  3. decubitus ulcers;
  4. increased ICP
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20
Q

What is the immediate Tx of neurogenic shock?

A
  1. Swan-Ganz for fluid monitoring;
  2. pressors
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21
Q

What are 3 characteristics of spinal shock?

A
  1. flaccid paralysis;
  2. Bradycardia hypotension;
  3. absent Bulbocavernosis reflex
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22
Q

What are 5 contraindications to high dose methylprednisone?

A
  1. GSW;
  2. pregnancy;
  3. under 13 yoa;
  4. > 8 hours post injury;
  5. Bracial plexus injuries
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23
Q

What are the indications for decompression and stabilization for SCI GSW?

A
  1. progressive neurological deficit with retained bullet;
  2. cauda equina;
  3. retained bullet fragment within thecal sac (CSF can lead to lead poisoning)
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24
Q

What are the W/C functions of: 1. C3-C4; 2. C5; 3. C6; 4. C7

A
  1. C3-C4 - electric W/C with chin controls;
  2. C5 - electric W/C with hand controls;
  3. C6 - manual W/C with sliding board transfers;
  4. C7 - manual W/C with independent transfers
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25
Q

What is the most common incomplete cord injury?

A

Central cord

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26
Q

What are 4 key characteristics of central cord syndrome?

A
  1. motor deficit more to u/e than l/e;
  2. sacral sparing;
  3. good prognosis;
  4. often have permanent clumsy hands
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27
Q

What is the order of recovery for central cord syndrome?

A
  1. l/e first;
  2. bowel/bladder;
  3. prox u/e;
  4. distal u/e
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28
Q

What is the pathophys. of anterior cord syndrome?

A
  1. direct compression;
  2. anterior spinal artery injury
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29
Q

What are the key points for anterior cord syndrome?

A
  1. l/e more than u/e;
  2. loss LCT (motor), LST (pain, temp);
  3. preserved DC (vib, proprioception);
  4. worst prognosis of ISCI
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30
Q

What is the pathophys. of Brown-Sequard syndrome?

A

penetrating trauma

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31
Q

What are the physical findings in Brown-Sequard syndrome?

A
  1. ipsilateral - motor (LCST) - light touch, proprioception (DC);
  2. contralateral - pain, temp, light touch (LSTT)
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32
Q

What is the prognosis of Brown-Sequard syndrome?

A

Excellent - 99% ambulatory @ final followup

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33
Q

What are the key points of posterior cord syndrome?

A
  1. rare;
  2. Dorsal column affected;
  3. proprioception/vibration gone;
  4. motor/pain/light touch preserved
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34
Q

What is the most common cause of cauda equina syndrome?

A

disc protrusion (herniation)

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35
Q

What are 4 complications of cauda equina syndrome?

A
  1. sexual dysfunction;
  2. urinary dysfunction;
  3. chronic pain;
  4. persistent leg weakness
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36
Q

What is the most common complication of cervical laminoplasty?

A

C5

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37
Q

What nationality has a high frequency of isthmic spondylothesis?

A

Eskimo - > 50%

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38
Q

What 4 ligaments stabilize the occipitoatlantoaxial complex?

A
  1. transverse ligaments;
  2. paired alar ligaments;
  3. apical ligament;
  4. tectorial membrane
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39
Q

What is the Anderson and Montesano classification of the occipital condyle #s?

A

Type I - impact #, stable;

Type II - Basilar skull # with extension, stable;

Type III - avulsed alar ligament, can be unstable

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40
Q

What are the indications for operative management for OC #s?

A
  1. Type III with instability;
  2. neural compression;
  3. associated atlantoaxial or atlas injuries; Tx with OC - C2 or C3 fusion
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41
Q

What are the classifications of occipitocervical D/L?

A

Type I - anterior;

Type II - longitudinal;

Type III - posterior

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42
Q

What is Powers Ratio and its importance?

A

diagram: Powers Ratio = CD/AB; normal = 1;
1. > 1 concern for anterior D/L;
2. <1 post D/L, dens #, atlas #

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43
Q

What is a major contraindication to traction in cervical spine injuries?

A

OC D/L due to high (10%) rate of neurologic injury

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44
Q

Where is the thickest portion of the occiput?

A

5 cm lateral to the external occipital protuberance

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45
Q

What is the major complication associated with OC-cervical fusion?

A

Damage to major dural venous sinus located just inferior external occipital protuberance

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46
Q

Where do you place screws for OC fusion?

A

Safe zone located 2 cm lateral to EOP + 2 cm inferior to the EOP (Danger is dural venous plexus)

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47
Q

What are 9 causes of atlanto-axial instability?

A
  1. Down syndrome;
  2. RA;
  3. Os odontoideum;
  4. Type I odontoid #s;
  5. atlas #s;
  6. transverse ligament injury;
  7. JRA;
  8. Morquio’s;
  9. rotary atlanto-axial subluxation
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48
Q

What is the most important stabilizer of C1-C2 stability?

A

transverse ligament

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49
Q

What ADI is considered unstable in adults?

A

3.5 mm

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50
Q

What ADI is Sx indication in RA?

A

> 10 mm

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51
Q

What PADI or sac is indication for Sx in RA?

A

<14 mm

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52
Q

What sum of lateral mass overhang indicates transverse ligament disruption?

A

8.1 mm

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53
Q

What is C1 # classification?

A

Type I - isolated anterior/posterior arch #s;

Type II - Jefferson-Burst #, bilateral ant/post arch #s;

Type III - unilateral lateral mass #

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54
Q

What are 3 non-op indications for C1 #s?

A
  1. stable type I #s;
  2. stable type II #s - <3 m ADI or <8.1 displacement;
  3. stable type III #s <8.1 mm displacement
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55
Q

What are the indications for C1-C2 fusion or OC C2-C3 fusion in C1 #s?

A
  1. unstable type II #s;
  2. unstable type III #s;
  3. occipitocervical fusion if OC joint involved or poor purchase in C1
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56
Q

What are the options for fusing C1-C2?

A
  1. C1 lateral mass, C2 pars;
  2. C1 lateral mass, C2 pedicle;
  3. transarticular with Gallie/Brook/bone graft enhancement
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57
Q

What is the blood supply to Dens/C2?

A
  1. apex is carotid;
  2. base is vert.
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58
Q

What is the Andonson and D’Azunzo classification of C2 #s?

A

Type I - tip avulsion #s;

Type II - waist #s;

Type III -# extends into body

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59
Q

What are the radiographic parameters for atlanto-axial instability in OS odontoideum?

A
  1. need flex-ex films;
  2. ADI = > 10 mm;
  3. Sac or PADI < 13 mm
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60
Q

What is the Tx algorithm for C2 #/instability?

A
  1. OS odontoideum - observe;
  2. type I - cervical orthoses, 6-12 weeks;
  3. type II young - halo if RF (-), Sx if RF (+);
  4. type II old - collar if not Sx candidate, Sx if candidate;
  5. type III - hard cervical collar for 6-12 weeks
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61
Q

What are the indications for C2 osteosynthesis?

A

Type II C2 # with:

  1. acceptable alignment;
  2. # line perpendicular to screw trajectory;
  3. body habitus allows trajectory
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62
Q

What are the risk factors for C2 type II non-union? (5)

A
  1. > 5 mm displacement;
  2. # comminution;
  3. > 10 degrees angulation;
  4. age > 50;
  5. delay in Tx > 4 days
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63
Q

What is the order of ossification of the Dens?

A

Dens to base - about 6 yoa;

Tip to Dens - about 12 yoa;

Tip ossifies @ age 3

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64
Q

What is Levine and Edward’s classification of C2 Hangman’s #s?

A
  1. Type I - <3 mm displacement - not angulated;
  2. Type II - >3 mm displacement + angulated vertical # line;
  3. Type IIA - same as above but horizontal # line;
  4. Type III - Type I with B/L C2-C3 D/L
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65
Q

What is the Tx of type I Hangman’s #?

A

rigid cervical collar X 4-6/52

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66
Q

What is the Tx of type II Hangman’s #?

A
  1. If <5 mm - traction + halo;
  2. If >5 mm consider C1-C2 fusion
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67
Q

What is the Tx of type IIA Hangman’s #?

A

AVOID TRACTION due to horizontal # line;

Reduction + halo X 6-12/52 weeks

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68
Q

What is the Tx of type III Hangman’s #?

A

open reduction of facets with stabilization

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69
Q

What are the operative options for unstable Hangman’s #?

A
  1. Anterior C2-C3 interbody fusion;
  2. posterior C1-C3 fusion;
  3. B/L C2 pars osteosynthesis
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70
Q

How much displacement do UNI vs B/L facet dislocations lead to?

A

UNI - 25%;

B/L - 50%

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71
Q

What percentage of facet D/L will fail closed reduction?

A

26%

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72
Q

What lumbar Dx study leads to accelerated degenerative disc disease?

A

provocative discography

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73
Q

What is the congenital cause of spinal steiosis and why?

A
  1. Achondoplasta;
  2. due to short pedicles + medially based facets
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74
Q

What is Kemp sign?

A

a unilateral radiculopathy made worse by bending backwards

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75
Q

Vasc. vs Neuro claudication? (5)

A

Neuro IS + postural, standing stationary, going up stairs easier, stationary bike easier, pulses normal

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76
Q

What are the 7 steps of pedicle to pedicle decompression?

A
  1. remove spine proc.;
  2. remove lamina to LF;
  3. preserve PARS int.;
  4. decompress pedicle above;
  5. decompress pedicle below;
  6. decompress lateral recess;
  7. ensure no disc remnant
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77
Q

When to instrument with ped-to-ped decomp. for spinal stenosis? (3)

A

With segmental instability:

  1. spondy (isthmic);
  2. spondy (degen.);
  3. degen. scoliosis
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78
Q

What 2 factors create instability in L-spine?

A
  1. complete laminectomy;
  2. > 50% facetectomy
79
Q

What is the most common cause of persistent pain following decomp. for spinal stenosis?

A

inadequate foraminal stensis

80
Q

What is the outcome of the Sport Trial?

A

Better function + pain scores @ 4 years

81
Q

What is Wiltse classification of spondylolisthesis?

A

Type I - dyplastic (congenital);

Type II - A-isthmic (fatigue #); B-isthmic (elongated ); C-isthmic (acute #);

Type III - degenerative;

Type IV - traumatic, not pars;

Type V - neoplastic

82
Q

What defines a motion segment instability on flex/ex L-spine?

A
  1. 4 mm or >;
  2. 10 degrees > movement than adjacent motion seg.
83
Q

What are the Myerding classifications?

A

Type I - <25%;

Type II - 25-50%;

Type III - 50-75%;

Type IV - 100%;

Type V - loptosis

84
Q

Is degen. spondy of L-spine more common to men or women?

A

8X in women

85
Q

What are the risk factors for degen. spondy? (3)

A
  1. woman;
  2. sacralization of L5;
  3. horizontal facets
86
Q

What is the procedure of choice for failed posterior decomp. and in-situ fusion for degen. spondy?

A

Revision decomp. + fusion with anterior support (ALIF)

87
Q

What are the risk factors for adjacent segment disease post decomp./fusion in L-spine? (4)

A
  1. age;
  2. increased levels you do;
  3. adjacent laminectomy;
  4. increases above L3
88
Q

What effect has pedicle screws had on lumbar fusion?

A

decreased rates of pseudarthrosis

89
Q

What is the most reliable predictor of clinical outcome of adult spinal deformity?

A

Sagittal balance

90
Q

How much correction can you get with a SPO (Smith Pete Osteotomy)?

A

up to 10 degrees

91
Q

How much correction can you get from a PSO (pedicle subtraction osteotomy)?

A

30-50 degrees

92
Q

How much correction can you get from a VCR?

A

up to 45 degrees usually in rigid thoracic kyphosis/scoliosis

93
Q

What are the indications for anterior procedures in adult spinal deformity? (4)

A
  1. curves > =70 degrees;
  2. rigid curves;
  3. isolated lumbar;
  4. L5/S1 ALIF when fusing to S1
94
Q

What are the risk factors for pseudarthrosis? (7)

A
  1. age > 55;
  2. kyphosis > 20 degrees;
  3. (+) sagittal balance > 5 cm;
  4. hip OA;
  5. smoking;
  6. thoraco abdominal approach;
  7. incomplete lumbo pelvic fixation
95
Q

What are the indications for posterior C1-C2 fusion in RA? (3)

A
  1. ADI => 10 mm;
  2. PADI/SAC - <14mm;
  3. progressive myelopathy
96
Q

What is the most reliable measurement of basilar invagination?

A

Ranawat classification <15 mm arch C1 to pedicule C2

97
Q

What is cervico-medullary angle and what is its meaning?

A

CMA <135 degrees suggest impending neuro impairment

98
Q

What are the risk factors for subaxial instability? (4)

A
  1. steroids;
  2. males;
  3. seropositive RA;
  4. nodules present
99
Q

What is the most reliable radiographic measurement to predict post-op neural recovery in RA C-spine Sx?

A

PADI >= 14 mm

100
Q

What are the diagnostic criteria of ANK sponds?

A
  1. bilateral sacroiliitis;
  2. +/- uveitis; 3. HLA B27 (+)
101
Q

What are the key physical exam tests for ANK sponds?

A
  1. chest wall expansion;
  2. Schober’s test;
  3. chin brow to vertical angle;
  4. hip flexion contraction;
  5. Faber test (sacroiliitis)
102
Q

What is the most sensitive test to Dx #s in ANK sponds?

103
Q

What is definition of DISH?

A

non-marginal syndesmophytes @ 4 contiguous levels (Forestier disease)

104
Q

What are the risk factors for DISH? (3)

A
  1. gout;
  2. hyperlipidemia;
  3. DM
105
Q

Why is DISH preserved in L thoracic spine?

A

pulse of aorta is protective in that region

106
Q

What do you need to counsel DISH patients undergoing THA?

A

HO (30-50%) <20 without DISH

107
Q

What is the most common demographic with OPLL?

108
Q

What is the surgical treatment for OPLL?

A
  1. anterior corpectomy +/- OPLL resection: a) kyphotic spine; b) OPLL falls within gap;
  2. posterior laminectomy + fusion - Lordotic spine
109
Q

Where and at what age are C-spine injuries more common? ie. upper/lower spine

A
  1. above C3 8 years old;
  2. below C3 > 8 year old
110
Q

What are the risk factors for C-spine injuries in children?

A
  1. head size;
  2. horizontal facets;
  3. lig. laxity;
  4. weaker muscles Number 2 through 4 increase physical motion
111
Q

How far can peds spinal cord stretch without rupture?

112
Q

What are the differences in C-spine between adults and peds?

A
  1. ADI 5 mm (N);

. C3 vertebrae wedge;

  1. loss of lordosis;
  2. C2-C3 or C3-C4 pseudosubluxation (N) posterolaminar line <4 mm (N)
113
Q

How do you determine how much cut-out is needed on a peds spine board?

A

Shoulders should be in-line with exterior auditory meatus

114
Q

What is the most common associated injury with peds C-spine injury?

A

head injury

115
Q

What are 4 reasons for increased mobility of peds C-spine compared to adults?

A
  1. increased ligament laxity;
  2. immature supporting structures;
  3. horizontal/shallow facets;
  4. NP has increased H2O content allowing movement
116
Q

What are the indications for TLSO in peds? (3)

A
  1. comp. #s <50% anterior height loss;
  2. Burst # with no neuro + <50% retropulsion;
  3. purely osseous flex/dist injury
117
Q

How do you differentiate pseudosubluxation form true C-spine subluxation in peds?

A
  1. <8 yoa pseudo;
  2. C2 on C3 pseudo;
  3. reduced with extension xray;
  4. C2 within 1.5 mm of Swischuk”s line;
  5. no Hx/PE trauma
118
Q

What are the common causes of atlanto-axial rotary displacement (AARD)? (6)

A
  1. trauma;
  2. Grisel’s disease (retropharyngeal irritation);
  3. Down syndrome;
  4. RA;
  5. tumor;
  6. congenital
119
Q

What is the Fielding classification of AARD?

A

Type I - uni facet subluxation;

Type II - uni facet with 5 mm anterolisthesis;

Type III - B/L facet with >5 mm anterolisthesis;

Type IV - posterial C1 displacement

120
Q

What is the gold standard test for AARD?

A

Dynamic CT

121
Q

What is the Tx algorithm for AARD?

A

subluxation:

<1 week - soft collar, NSAIDS, physio;

> 1 week - head halter traction - 5 lbs;

> 1 month - halo traction; > 3 months or neuro - posterior C1-C2 fusion

122
Q

What are associated conditions in Klippel-Feil syndrome? (10)

A
  1. congen. scoliosis;
  2. Sprengel’s;
  3. renal aplasia;
  4. synkinesis;
  5. heart disease
  6. basilar invagination;
  7. AA instability (C1-C2);
  8. cervical stenosis;
  9. brainstem anomolies;
  10. adjacent level disease
123
Q

What is the classic triad of Klippel-Feil syndrome?

A
  1. low posterior hair line;
  2. short webbed neck;
  3. decreased cervical ROM; Classic triad is seen in fewer than 50%
124
Q

What are the surgical indications for Klippel-Feil syndrome?

A
  1. basilar invagination;
  2. chronic pain;
  3. myelopathy;
  4. C1-C2 instability;
  5. adjacent level disease
125
Q

What tests must be ordered in Klippel-Feil syndrome? (2)

A
  1. cardiac U/S;
  2. renal ultrasound
126
Q

What makes the decision whether or not Klippel-Feil patients can play contact sports?

A

cervical spine fusion above C3

127
Q

What are the physical exam findings in congenital muscular torticollis?

A

head tilts toward affected side + rotates away

128
Q

What is the imagine modality of choice to differentiate congenital torticollis from severe pathology?

129
Q

What is the Tx algorithm for congenital muscular torticollis?

A
  1. If <1 year + <30 degrees - stretching (90% success);
  2. If >1 year - a) botox, b) Z-plasty, c) bipolar 5 cm release
130
Q

What is the most common curve type for AIS?

A

right thoracic

131
Q

What are the risk factors for curve progression in AIS? (8)

A
  1. magnitude > 25 degrees before skeletal maturity;
  2. <12 yoa;
  3. Tanner <3 (females);
  4. Risser 0-1;
  5. open triradiate;
  6. before menarche;
  7. thoracic >lumbar curves;
  8. double > single
132
Q

What are the key physical findings for AIS? (scoliosis) (7)

A
  1. Adams forward bend;
  2. skin defects (spina bifida);
  3. shoulder height differences;
  4. cafe-au-lait;
  5. foot deformities (Cavovarus);
  6. asymmetric abdominal reflexes;
  7. thorough NV exam
133
Q

How can you measure coronal balance?

A

C7 plumb to CSVL (diagram)

134
Q

What are the indications for MRI in AIS (scoliosis)? (8)

A
  1. L thoracic curve;
  2. rapid progression;
  3. excessive kyphosis;
  4. structure anomolies (congenital);
  5. neuro Sx or pain;
  6. foot deformities;
  7. asymmetric ABDO reflexes;
  8. short angular curve
135
Q

What are the indications for observation, bracing and Sx for AIS? (scoliosis)

A
  1. obs. - <25 degrees;
  2. brace - 25-50 degrees, flexible curves, Risser 0,1,or 2;
  3. Sx - Cobb >45 degrees
136
Q

What are the indications for anterior/posterior Sx for AIS? (scoliosis)

A
  1. > 75 degrees;
  2. young age - girls <10, boys <13, Risser 0; prevent crankshaft
137
Q

How do you define skeletal maturity for patient for AIS?

A
  1. Risser 4;
  2. 2 year post menarchal;
  3. <1 cm growth over 2 visits 6 months apart
138
Q

What is stable vertebrae in scoliosis?

A

most cephalad vertebrae that is bisected by CSVL

139
Q

Where should you stop proximal fusion in AIS Sx? (scoliosis)

A

1 or 2 levels above stable vertebrae

140
Q

What is the risk of fusing to L4 or L5 in AIS Sx? (scoliosis)

A

increased incidence of low back pain as described by Cochrane

141
Q

What is the definition of intra-op neuro event as defined by SSEP’s/MEP’s during spine manipulation?

A

a drop in amplitude > 50%

142
Q

What is the algorithm for intra-op neuro event? (6)

A
  1. check technical error;
  2. check for low BP + Tx;
  3. check for low Hgb + Tx;
  4. lessen/reverse correction;
  5. remove instrumentation;
  6. implement wake up test
143
Q

What is the most common bug for late spine infections?

A

P. Acnes (just like shoulder)

144
Q

What are 2 medical complications of scoliosis Sx?

A
  1. staph.;
  2. superior mesenteric artery syndrome
145
Q

What is the #1 risk factor for pseudarthrosis following scoli corrective Sx?

A

thoracic hyperkyphosis

146
Q

List 6 neural axis abnormalities in idiopathic scoliosis.

A
  1. syringomyelia;
  2. Chiari;
  3. tethered cord;
  4. diastematomyelia;
  5. dysraphism;
  6. spinal cord tumor
147
Q

What are the indications for an MRI in juvenile idiopathic scoliosis?

A
  1. age <10;
  2. curve >20 degrees
148
Q

What is the Tx algorithm for juvenile idiopathic scoliosis?

A

skeletally immature patient, growing rods for curves > 50 degrees, then PSF +/- ASF once reaches skeletal maturity

149
Q

What is the inheritance pattern of infantile idopathic scoliosis?

A

autosomal dominant

150
Q

What should one look for on xrays in infantile idiopathic scoliosis?

A
  1. Cobb angle;
  2. vertebrae rib overlap;
  3. RVAD (rib vertebrae angle difference) - > 20 degrees has an increased risk of progression, < 20 degrees associated with spontaneous recovery
151
Q

What are the indications for Mehta casting or TLSO in infantile idiopathic scoliosis?

A
  1. phase II ribs;
  2. RVAD > 20 degrees;
  3. Cobb > 25-30 degrees;
  4. flexible curves
152
Q

What are the indications for growing rod construction in infantile idiopathic scoliosis?

A
  1. Cobb > 50 degrees;
  2. failed Mehta casting/bracing
153
Q

What are the indications for Sx in neuro scoliosis in CP?

A
  1. curve > 50 degrees;
  2. pelvic obliquity with sitting imbalance
154
Q

In what 2 neuro scoliosis is bracing contraindicated?

A
  1. muscular dystrophy;
  2. spina bifida
155
Q

What are the indications for scoliosis correction in muscular dystrophy?

A
  1. curve > 20 degrees;
  2. progressive curve;
  3. Tx before respiratory decline
156
Q

What are the causes (syndromes) for neuro scoliosis? (5)

A
  1. CP;
  2. SMA;
  3. muscular dystrophy;
  4. spina bifida/trauma;
  5. polio
157
Q

What type of CP is most at risk of developing scoliosis?

A

spastic quadriplegia

158
Q

When should one extend to pelvis in CP scoliosis? Why?

A
  1. If pelvic obliquity > 15 degrees;
  2. to prevent pseudoarthrosis
159
Q

What are the key components of pre-op assessment of CP scoliosis patient?

A
  1. multi-disciplinary;
  2. nutritional status > 3.5 g/dl albumin;
  3. respiratory status;
  4. GI evaluation (GERD = aspiration);
  5. neuro function (seizure disorder) If valproic acid, then increased bleeding risk
160
Q

What are the common causes of pathologic scoliosis?

A
  1. osteoid osteoma;
  2. osteoblastoma
161
Q

What are 2 positive prognostic factors for spontaneous resolution of scoliosis following osteoid osteoma resection?

A
  1. child <10 yoa;
  2. resection occurred within 15 months of onset of scoliosis
162
Q

What are the syndromes associated with congenital scoliosis?

A
  1. VACTERL;
  2. Goldenhar;
  3. Jarcho-Levin;
  4. Klippel-Feil;
  5. Alagille syndrome
163
Q

Which vertebrae morphology is associated with the highest progression of curve in congenital scoliosis?

A

unilateral unsegmented BAR with contralateral hemivertebrae

164
Q

Which vertebrae morphology is least likely to cause curve progression in congenital scoliosis?

A

block vertebrae

165
Q

What are 3 mandatory tests in congenital scoliosis?

A
  1. MRI spine;
  2. echocardiogram;
  3. renal U/S
166
Q

What neural axis defects are found in congenital scoliosis?

A
  1. syrinx;
  2. diastematomyelia;
  3. tethered cord;
  4. Chiari;
  5. intradural lipoma
167
Q

What are the indications for scoliosis corrective Sx in congenital scoliosis?

A
  1. significant progression;
  2. neuro deficits;
  3. respiratory failure;
  4. failure of formation with contralateral failure of segmentation
168
Q

How does one decide on posterior or anterior + posterior scoliosis correction in congenital scoliosis?

A
  1. AGE - <12 boys and <10 girls - anterior/posterior, +/- growing rods; >12 boys and >10 girls post insitu;
  2. failure of formation with failure of segmentation = ant/post +/- vertebrectomy
169
Q

What are the indications for hemiepiphysiodesis in congenital scoliosis? (3)

A
  1. patient <5 yoa;
  2. intact discs/growth plates on concave side;
  3. curve <40-50 degrees
170
Q

What is the definition of Scheuermann’s kyphosis?

A
  1. > 45 degrees;
  2. anterior wedge of > 5 degrees across 3 vertebrae
171
Q

What is the inheritance pattern of Scheuermann’s kyphosis?

A

autosomal dominant

172
Q

What is the normal thoracic kyphosis range?

A

25-45 degrees T5-T12

173
Q

What is the Tx algorithm for Scheuermann’s kyphosis?

A
  1. observe if <60 degrees;
  2. brace and observe if 60-80 degrees + Risser <3;
  3. PSF with rods +/- interbody fusion a)kyphosis >75 degrees and rigid, b) neuro deficit, c) cord compression, d) severe pain in adults
174
Q

What is the mechanism of spondy in adolescents?

A

repetitive micro #s due to hyperextension stress (gymnast, lineman, weight lifter)

175
Q

What is a listhetic crisis in peds spondy?

A
  1. severe back pain - worse with extension and relieved by rest;
  2. neuro deficit;
  3. hamstring spasm
176
Q

What are the special physical exam tests for peds spondylolisthesis?

A
  1. single limb stance;
  2. popliteal angle for hamstring tightness;
  3. detailed neuro exam
177
Q

What is the first investigation to do when lumbar pain in adolescent?

178
Q

What is the next investigation to do in lumbar pain in peds if xrays are negative?

179
Q

Can kids with spondylolisthesis participate in contact sports?

A
  1. Asymptomatic low grade (ie. I or II) - Yes;
  2. Symptomatic low grade (ie. I or II) - No
180
Q

What is the Sx and Tx algorithm for spondylolisthesis in peds?

A
  1. low grade failed cons. management - L5-S1 in situ fusion;
  2. high grade failed cons. mangement - L4-S1 in situ fusion
181
Q

What is the most common nerve root injury with spondylolisthesis reduction?

182
Q

What is the most common location for discitis inpeds?

183
Q

What is the earliest xray finding in peds discitis?

A

loss of lumbar lordosis

184
Q

What is the Tx algorithm for peds discitis?

A

First, Tx IV antibiotics X 4-6 weeks;

Follow ESR/CRP if:

a) positive response then continue;
b) abcess/neuro go to surgical decompression;
c) negative response then CT guidedbiopsy R/O TB

185
Q

What are the indications for closed cervical traction? (5)

A
  1. subaxial C-spine with malalignment;
  2. facet D/L;
  3. displaced odontoid;
  4. some Hangman’s #s;
  5. C1-C2 rotatory subluxation
186
Q

What are 4 suspicious factors (red flags) for mets in vertebrae compression #s?

A
  1. # s above T5;
  2. atypical;
  3. constitutional Sx;
  4. younger patient with no fall
187
Q

What are the components of spien PLC?

A
  1. supraspinous ligament;
  2. interspinous ligament;
  3. ligamentum flavum;
  4. facet joint capsules
188
Q

What are the risk factors for degenerative disc disease?

A
  1. obesity;
  2. smoking;
  3. gender;
  4. lifting;
  5. vibration;
  6. prolonged sitting;
  7. job dissatisfaction
189
Q

What are the Waddell signs?

A
  1. non-anatomical tenderness;
  2. pain with axial compression of the spine;
  3. reduced pain of SLR with distraction;
  4. non-dermatomal/myotomal ;
  5. over reaction to P/E
190
Q

What is the most common level of disc herniation?

191
Q

What is the mechanism of disc herniation reabsorption?

A

macrophage phagocytosis

192
Q

How does one differentiate between recurrent disc and fibrosis post lumbar disc Sx?

A

MRI with GAD

  1. fibrosis enhances with GAD;
  2. recurrent disc does not enhance with GAD
193
Q

What are the positive predictors post lumbar disc Sx?

A
  1. leg pain as chief component;
    • SLR;
  3. weakness correlated with MRI;
  4. married
194
Q

What is the most influential negative predictor post lumbar disc Sx?

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